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Accurate  portrait  of  E PUR  AIM  McDOWELL,  M.D.,  when  57  years  of  age 
{1828),  taken  from  an  oil  painting,  made  from  life  by  the  celebrated  artist, 
"Davenport " 

(Copyright  1897,  by  Mrs.  M.  T.  Valentine.) 


Ai'ctanl>«Uu)o;    Nosy    youna 


BIOGRAPHY 


ephraim  Mcdowell,  m.d. 

"THE  FATHER  OF  OVARIOTOMY." 
BY   HIS   GRANDDAUGHTER, 

MRS.  M.  T.  VALENTINE. 


WITH 

VALUABLE   SCIENTIFIC   TREATISES   AND   INTERESTING 

MONOGRAPHS   ON  OVARIOTOMY, 

\  AND 

Eulogistic  Letters,  and  Addresses  by  Eminent  Members  of  the 
Medical  Profession  in  Europe  and  America. 


REVISED  EDITION. 


NEW  YORK,  N.  Y., 

Mcdowell  publishing  company, 

24-26  West  Twenty- second  St. 
1897. 


X  1^4 .  Mil 


Entered  according  to  Act  of  Congress  in  the  year  1897, 

BY  MRS.  M.  T.  VALENTINE, 

In  the  Office  of  the  Librarian  of  Congress,  at  Washington,  D.  C. 


DORNAN,  PRINTER, 
PHILADELPHIA,  PA. 


TO  THE  MEDICAL  PROFESSION 

AND   TO   THE 

EARNEST    WORKERS    IN    THE    FIELD    OF    SURGER1 

WHO   REVERE  THE   MEMORY  OF 

ephraim  Mcdowell,  m.d. 

%§is  "g$ox&  is  ^.ffectionaiett)  gttsmSeb, 

BY  HIS   GRANDDAUGHTER, 

MRS.  M.  T.  VALENTINE. 


NOTE. 

Occasional  repetition  of  facts  recorded  in  medical  works  will  be 
found  in  this  book.  This  is  owing  to  the  articles  containing  these 
repetitions  having  been  written  by  eminent  surgeons  who  were  not 
aware  of  what  had  already  been  contributed,  and  to  the  fact  that  a 
portion  of  the  work  had  been  electrotyped  previous  to  the  reception 
of  these  articles. 


PREFACE. 


Dr.  Ephraim  McDowell,  the  subject  of  this  memoir, 
has  rested  from  his  earthly  labors  sixty  years,  and  the 
reader  will  naturally  wonder  why  so  great  a  length  of 
time  should  have  elapsed  before  his  biography  had  been 
written.  Although  notices  of  his  wonderful  career  as  a 
surgeon  have  appeared  from  time  to  time,  notably  one 
written  by  the  late  Professor  S  D.  Gross,  yet  no  detailed 
account  of  his  private  life  has  heretofore  been  given  to 
the  public^ 

At  the  present  time  laparotomy  is  appreciated  and 
practised  by  the  entire  surgical  world,  and  countless 
thousands  are  yearly  being  saved  by  McDowell's  operation, 
ovariotomy.  Each  year  the  desire  and  interest  becoming 
greater  to  know  who  this  man  was,  and  what  prompted 
him  first  to  insert  the  knife  into  the  abdomen,  led  to  a 
determination  on  the  part  of  several  of  the  most  prominent 
surgeons  of  America  to  request  some  one  of  his  de- 
scendants to  give  to  the  world  all  the  facts  of  interest 
that  could  be  gathered  relating  to  the  life  of  this  daring 
surgeon.  Hence  the  Author  of  this  work,  by  request, 
has  prepared  The  Biography  of  Ephraim  McDowell, 
M.D.,  trusting  that  her  labors  will  be  appreciated, 
and  the  work  prove  a  fitting  tribute  to  the  memory  of 
one  whose  entire  life  was  devoted  to  the  cause  of  suffering 
humanity. 

We  are  largely  indebted  to  Col.  Thomas  Marshall  Green, 
of  Maysville,  Kentucky,  for  a  correct  and  graphic  history 
of  the  antecedents  of  Dr.  McDowell,  the  persecutions  of 

(v) 


VI 


PREFACE. 


the  family,  and  the  flight  of  its  members  from  their  native 
country,  together  .with  an  account  of  their  success  and 
progress  after  settlement  in  America.  We  understand  that 
Col.  Green  has  searched  diligently  the  family  records  to 
obtain  everything  of  interest  connected  with  our  subject, 
hence  we  are  secure  in  quoting  from  his  work,  entitled 
Historic  Families  of  Kentucky,  in  following  the  ancestral 
line  of  Dr.  Ephraim  McDowell. 

Professor  Eugene  Cord  ell,  of  Baltimore,  Md.,  after  great 
difficulty  and  delay,  kindly  procured  a  copy  of  the  original 
diploma  awarded  to  Dr.  McDowell  in  the  year  1825. 

We  are  indebted  to  Col.  J.  McD.  Alexander,  of  Virginia, 
for  three  very  interesting  letters,  one,  bearing  date  of  1792, 
written  to  the  grandfather  of  Col.  Alexander,  and  two,  in 
1793,  to  Ephraim  McDowell,  while  he  attended  the  lectures 
in  Edinburgh,  Scotland. 

Dr.  Edwin  A.  Peaslee,  of  New  York  City,  kindly  loaned 
us  the  use  of  the  fine  steel-plate  of  Dr.  McDowell,  which 
likeness  he  had  engraved  from  a  daguerrotype  furnished 
by  the  late  Mrs.  McDowell,  forming  the  frontispiece  of 
this  work. 

Dr.  Coleman  Rogers,  of  Louisville,  Ky.,  also  kindly 
presented  us  with  several  copies  of  the  ' '  memorial  services, ' ' 
held  in  Danville,  Ky.,  at  the  dedication  of  the  monument 
erected  to  the  memory  of  Dr.  Ephraim  McDowell  by  the 
Kentucky  State  Medical  Society,  May  14,  1879. 

As  addenda  to  this  life  of  Dr.  McDowell,  there  will  be 
found  contributions  from  some  of  the  leading  ovariotomists 
of  America  and  Europe,  which,  when  considered  in  com- 
bination, will  be  found  possessed  of  the  value  of  a  complete 
text-book  on  the  subject.  In  these  articles  is  considered 
everything  that  relates  to  the  matter  in  its  most  advanced 
development.  Also  every  incident  of  interest  connected 
with  the  private  life  of  this  remarkable  man  will  be  found 
in  this  work. 

Dr.  Nathan  Bozeman,  of  New  York  City,  has  given  us 
an  ably-written  article  comprising  many  points  of  deep 


PREFACE.  vji 

interest  to  the  medical  profession.  He  has  prepared  his 
article  especially  for  the  Biography  of  Ephraim  McDowell, 
M.D.,  and  has  spared  no  pains  in  its  preparation. 

Through  the  kindness  of  Dr.  John  H.  Mclntyre,  of 
St.  Louis,  Mo.,  we  have  been  furnished  with  a  detailed 
description  of  the  operation  of  ovariotomy,  giving  the 
reader  an  opportunity  of  comparing  the  present  mode  of 
operating  with  that  first  given  to  the  profession  by  Dr. 
McDowell,  in  the  year  1809.  We  were  desirous  of  obtain- 
ing an  article  descriptive  of  ovariotomy  from  the  able 
writer,  Dr.  William  Goodell,  of  Philadelphia,  Pa. ;  but, 
on  his  careful  reading  of  Dr.  Mclntyre's  paper,  Dr. 
Goodell  remarked,  "  The  article  from  Dr.  Mclntyre  covers 
the  entire  ground  of  ovariotomy,  and  I  could  not  add  to 
or  take  from  it  one  word.       I  think  it  admirable." 

To-  Professor  William  Tod  Helmuth,  of  New  York  City, 
we  extend  our  heartfelt  thanks  for  his  valuable  article,  pro- 
nouncing Dr\  Ephraim  McDowell  "the  father  of  ovari- 
otomy" the  world  over,  and  for  many  other  kindnesses 
received  at  his  hands. 

Dr.  Lewis  S.  McMurtry,  of  Kentucky,  will  please  accept 
thanks  for  the  sketch  of  Dr.  Ephraim  McDowell,  by  the  late 
Dr.  John  D.  Jackson,  of  Danville,  Ky. 

We  are  also  under  obligations  to  Dr.  W.  W.  Dawson, 
of  Cincinnati,  O.,  Prof.  D.  W.  Yandell,  of  Louisville, 
Ky.,  and  Prof.  Walter  Coles,  of  St.  Louis,  Mo.,  for 
valuable  articles. 

We  are  pleased  to  refer  to  the  late  Dr.  Washington  L. 
Atlee,  of  Philadelphia,  who  did  so  much  toward  reestablish- 
ing "ovariotomy."  His  work  entitled  Ovarian  Tumors, 
is  dedicated  in  part  "  to  the  memory  of  Ephraim  McDowell, 
M.D.,  of  Kentucky,  the  founder  of  ovariotomy  in  1809." 

Drs.  W.  Gill  Wylie  and  Augustin  H.  Goelet,  of  New 
York  City,  and  Dr.  Richard  J.  Levis,  of  Philadelphia,  Pa., 
kindly  contributed  to  this  work. 

It  also  gives  us  pleasure  to  acknowledge  our  full  appre- 
ciation of  all  favors  extended  to  us  during  the  preparation 


viii  PREFACE. 

of  this  work,  by  Drs.  Lewis  A.  Sayre,  George  F.  Shrady, 
Fordyce  Barker,  T.  Gaillard  Thomas,  and  William  M. 
Polk,  of  New  York  City ;  Drs.  D.  Hayes  Agnew,  A.  R. 
Thomas,  and  Joseph  Price,  of  Philadelphia,  Pa. ;  Drs. 
Oliver  Wendell  Holmes  and  Henry  J.  Bigelow,  of  Boston, 
Mass. ;  Drs.  Charles  T.  Parkesand  E.  C.  Dudley,  of  Chicago, 
111.  3  Dr.  Dudley  S.  Reynolds,  of  Louisville,  Ky. ;  Dr. 
Dowling  Benjamin,  of  Camden,  N.  J. ;  and  our  many 
medical  friends  in  St.  Louis,  Mo.,  and  elsewhere,  who 
are  too  numerous  to  individualize. 

Sir  T.  Spencer  Wells  and  Dr.  George  Granville  Bantock, 
London,  England;  Professor  A.  R.  Simpson  and 
Willoughby  Walling,  U.  S.  Consul,  Edinburgh,  Scotland; 
Charles  William  McDowell,  Esq.,  of  Otter  Holt,  Carlow, 
Ireland;  M.  Starkloff,  U.  S.  Consul,  Bremen,  Germany; 
and  many  other  eminent  surgeons  abroad  have  expressed 
their  appreciation  of  Dr.  Ephraim  McDowell,  and  his  won- 
derful achievements  in  surgery,  by  eulogistic,  letters  and 
valuable  articles,  some  of  which  will  be  found  in  this  work. 

Professor  James  E.  Garretson  was  kind  enough  to  lend 
the  value  of  the  literary  experience  of  "John  Darby"  to 
the  Author  in  a  reading  and  revision  of  her  book  as  it 
went  through  the  press,  a  favor  more  than  duly  appreciated 
and  valued.  Where  remaining  faults  are  noticed,  blame 
belongs  alone  to  her. 

Were  we  to  attempt  to  enumerate  the  courtesies  and 
kindnesses  extended  us  by  the  medical  profession,  a 
detailed  account  would  fill  a  volume.  We  can  only  say 
that  their  words  of  encouragement,  and  full  appreciation 
of  our  labors,  have  urged  us  on  to  the  completion  of  this 
book,  and  engraven  upon  our  heart  a  feeling  of  friendship 
that  the  blighting  hand  of  time  cannot  obliterate,  and 
it  will  be  a  link  to  the  memory  of  Dr.  Ephraim  McDowell. 

The  several  medical  journals  which  have  so  kindly 
noticed  our  work  in  advance  of  its  publication  are  most 
gratefully  remembered  by 

The  Author. 


CONTENTS. 


PAGB 

I.     Introduction. 

This  Work  Contains  all  that  has  yet  been  Discovered  in  the 

Field  of  Ovariotomy 2 

Circumstances  that  Prompted  McDowell  to  Perform  the  First 

Operation 2 

Material  for   the   Work   Collected   by  the   Granddaughter   of 

McDowell 3 

Action  Taken  in  Commemoration  of  McDowell,  by  the  American 

Medical  Association,  held  at  Louisville,  Ky.,  May  4-7, 1875         4 

Earnest  Efforts  of  Drs.  John  D.  Jackson  and  Lewis  A.  Sayre, 

to  have  a  Monument  Erected  to  the  Memory  of  McDowell       10 

Dr.  McMurtry  Subsequently  Engaged  in  Completing  this  Under- 
taking        11 

Characteristics  of   Mr.  John  Bell,  Preceptor  of   McDowell,  in 

Edinburgh,  Scotland 12 

II.     Ancestral  Line  of  Dr.  Ephraim  McDowell. 

Origin  of  the  Name  of  McDowell 15 

McDowell  of  the  Race  Known  as  the  Scotch-Irish 16 

Arrival  of  McDowell's  Ancestors  in  Pennsylvania,  Sept.  4,  1729  19 

Samuel  McDowell,  Father  of  Dr.  McDowell,  Born  Oct.  29, 1735  28 
Dr.  Ephraim  McDowell,  Born  in  Rockbridge  County,  Virginia, 

November  11,  1771 33 

III.  Early    Life   of  Ephraim   McDowell   and   His 

Educational  Advantages. 

Dr.  McDowell's  Removal  to  Kentucky  when  Thirteen  Years  Old  34 

Description  of  McDowell  at  the  Age  of  Manhood 37 

McDowell  Attended  Lectures  at  the  University  of  Edinburgh, 

Scotland,  in  1793-4 38 

Interesting  Letters  to  McDowell  from  his  Father,  in  1793      .     .  40 

IV.  Return  from  Edinburgh. 

McDowell's  Return  to  Danville,  Kentucky,  in  1795       ....       51 
Marriage  of  McDowell  in  1802 55 

(ix) 


x  CONTENTS. 

PAGE 

An  Incident  Connected  with  McDowell's  Study  of  Biology  .     .  58 

McDowell's  Characteristics 59 

Record  of  McDowell's  Children 60 

Historical  Account  of  Gov.  Shelby,  of  "  Kings  Mountain  "  Fame  62 
Indian   Legend   Connected  with  the  Naming  of  McDowell's 

Homestead — ''Cambiskenneth  " 65 

McDowell  as  a  Slave  Owner 66 

Prayer  of  McDowell  Previous  to  His  First  Ovariotomy     ...  68 

V.     The  First  Case  of  Ovariotomy. 

First  Operation  was  Performed  on  Mrs.  Crawford,  December 

I3>  l8°9 7° 

Nature  and  Hazard  of  this  First  Operation 71 

Personal  Description  of  the  Heroic  Mrs.  Crawford  .....  73 
Acknowledgment  of  McDowell's  Daring  Skill,  by  the  Medical 

Society  of  Philadelphia,  in  18 17 74 

Copy  of  Diploma  Awarded  to  McDowell  in  1825 75 

Operation  on  James  K.  Polk  by  McDowell,  with  Letter  of  Appre- 
ciation from  Patient 77 

McDowell's  Crossing  the  Ocean  on  Three  Occasions  to  do  the 

Caesarean  Section 78 

One  Instance  of  McDowell's  Charity  in  Undertaking  a  Perilous 
Journey   of    Over   One    Hundred    Miles   to   Gratuitously 

Perform  Ovariotomy .     .     .     .  83 

VI.     Persecutions. 

"A  Great  Theory  Never  Accepted  without  Opposition"   ...  85 

Dr.  Hunn's  Misrepresentations  and  Scandalous  Allegations  .     .  86 

Negroes  Regarding  McDowell  with  Suspicion  and  Horror     .     .  88 

McDowell  made  a  Target  by  an  Envious  Pretender — Dr.  Hunn  89 

Interesting  Article  Contributed  by  Prof.  William  Tod  Helmuth  90 

VII.     Death  of  Dr.  Ephraim  McDowell. 

Dr.  McDowell  Passed  from  His  Earthly  Labors,  June  20,  1830  100 

Dr.  McDowell's  Virtues,  and  His  Abiding  Faith  in  His  Creator  102 

Pecuniary  Circumstances  of  the  Deceased  Surgeon 104 

Desolation  and  Death  of  Mrs.  Dr.  McDowell       ......  105 

Removal  of  Dr.  and   Mrs.  McDowell's  Remains  to  Danville, 

Ky.,  in  1879 IQ6 

VJII.     Criticisms  and  Comments. 

Dr.  Ezra  Michener's  Sarcastic  Allusions  to  McDowell  ....  108 

Dr.  Washington  L.  Atlee's  Early  Persecutions 109 


CONTENTS.  xj 


PAGE 

Mr.  Lawson  Tait's  Comments lx- 

Reply  to  Mr.  Tait  by  the  Authoress n8 

Statistics    and    Remarks    Regarding    Ovariotomy   in    Various 

Countries,  by  Dr.  E.  Randolph  Peaslee 120 

Tables  of  Completed  Ovariotomy  in   the  United  States,  Great 

Britain,  France,  and  Germany  up  to  1872 136 

IX.  Comments  upon  Ovariotomy. 

Dr.  Washington  L.  Atlee's  "  Diagnosis  of  Ovarian  Tumors  "     .  142 
Dr.  Peaslee  publishes,  in  1872,  Facts  establishing  Dr.  McDowell's 

Priority  as  an  Ovariotomist I52 

Prof.  W.  Gill  Wylie's  Report  on  no  Cases  of  Laparotomy   .     .  154 

Dr.  Augustin  H.  Goelet  in  Favor  of  Electricity ISS 

X.  Joseph  Nashe  McDowell,  M.D 

The  "McDowell  Medical  College,"  in  St.  Louis,  Mo.,  Founded 

by  Dr.  J.  N.  McDowell is8 

The  Doctor's  Peculiarities  in  Treating  Patients 160 

His  Emaciated  Form  Suggests  the  Pseudonym  of  "  Sawbones  "     162 
Cause  of  Alienation  Between  Dr.  J.   N.   McDowell  and  His 

Uncle,  Dr.  Ephraim  McDowell ,  zQo 

Meeting  of  the  Authoress  with  Dr.  J.  N.  McDowell,  at  a  Dread- 
ful Collision  Between  Two  Trains  of  Union  and  Confeder- 
ate Wounded  Soldiers  and  Refugees j66 

Wreck  of  the  McDowell  Medical  College,  and  its  Restoration     167 
The  Doctor's  Crank  Idea  in  Setting  Apart  and  Designating  One 

Room  as  "  Hell  " xg 

Eccentricities  of  the  Doctor I7I 

Death  of  Dr.  Joseph  Nashe  McDowell,  October  3,  1868    ...     176 
Father  De  Smit's  Conversion  of   Dr.  J.  N.  McDowell  to  the 

Roman  Catholic  Faith I78 

The  Doctor's  Idiosyncrasy  Regarding  the  Burial  of  His  Infant 

Children I7g 

Biographical  Sketch  of  the  Late  Col.  Basil  Duke  (a  Relative  of 
Joseph  Nashe  McDowell,  M.D.)  States  the  Fact  that  a  Few 
Years  Ago  Europe  Erected  a  Suitable  National  Monument 
to  the  Memory  of  Dr.  Ephraim  McDowell 180 

XL     Biographical  Sketch    of   Ephraim   McDowell, 
M.D.,  by  the  Late  Dr.  John  D.  Jackson. 

Dr.  Jackson's  Great  Veneration  for  McDowell zsj 

McDowell  Performed  Every  Surgical  Operation  then  Known  to 

Science 182 


CONTENTS. 


Dr.  James  Johnson  Asks  Pardon  of  God  and  of  Dr.  Ephraim 

McDowell,  for  His  Uncharitableness  Toward  the  Doctor     .     183 
McDowell's  Reply  to  His  Critics,  and  Ardent  Wish  that  the 

Operation  of  Laparotomy  may  not  be  Abused 184 

Liberality  of  Mr.  Overton,  of  Tennessee 185 

McDowell  Remarkable  for  His  Strength  and  Agility     ....     191 

McDowell's  Method  of  Treating  Fever 193 

McDowell's  Coolness  and  Dexterity  as  an  Operator  ....  195 
All  Women  Should  Bless  the  Name  of  Ephraim  McDowell  .  .  197 
United  States  of  America  Should  Erect  a  Fitting  Monument  to 

His  Memory .     .     .     .     198 

Bronze  Statue  of  Dr.  Ephraim  McDowell  Should  be  Erected 
Solely  from  Voluntary  Contributions  made  by  those  Women 
who  Owe  their  Lives  to  Ovariotomy 199 


XII.     Sketch  by  W.  W.  Dawson,  M.D. 

Address  Delivered  Before  the  "  American  Medical  Association/' 

at  Newport,  R.  I.,  in  1889,  by  W.  W.  Dawson,  M.D.     .     .     201 
Statistics  of  the  First  Medical  Schools  Formed  in  America     .     .     202 

XIII.  Description   of  One  of  the  Methods  of  Per- 

forming Ovariotomy,  by  Dr.  John  H. 
McIntyre,  of  St.  Louis,  Mo. 

"  McDowell  Cut  Away  the  Abdominal  Barriers,  and  the  Sur- 
geons Walked  In  and  Reaped  the  Harvest  of  his  Daring 
Surgical  Adventure " 210 

Sir  James  Paget  stated — "This  Operation  is  One  of  the  Greatest 

Achievements  of  Surgery  " 213 

Lord   Selborne   regarded    Ovariotomy  as   "  One   of   the    Most 

Splendid  Triumphs  of  Modern  Surgical  Art ''.....     215 

Dr.  John  H.  Mclntyre's  Method  of  Performing  the  Operation     216 

XIV.  McDowell's  Operation  of  Ovariotomy  by  the 

Long  Incision  during  the  First  Thirty- 
three  Years  of  its  Employment.  With  Com- 
ments. By  Nathan  Bozeman,  M.D.,  of  New 
York  City. 

in  tr  ob  uction. 

McDowell's  Operation  of  Ovariotomy.     His  Cases  and  Success. 

Their  Influence  on  the  World 228 


CONTENTS.  xiii 

PAGE 

Names  Made  to  Precede  McDowell's  in  Tables  of  Statistics  .  .  231 
McDowell's  Name  Placed  by  Mr.  Benjamin  Phillips,  of  England, 

in  his  Statistics  at  the  Head  of  the  List  of  Operators      .     .  232 

McDowell's  Claims  Accorded  by  Prof.  Samuel  D.  Gross  .     .     .  233 

Acknowledged  as  the  Founder  of  Ovariotomy  by  Dr.  Atlee  .     .  234 

Statistics  by  Surgeons  at  Large  Regarding  McDowell's  Priority  235 

The  Long  Incision 236 

Le  Dran's  Observations  and  Experiences,  1736  to  1746      .     .     .  238 

Delaporte's  Operation 239 

Incisionism  and  the  Drainage  Tube 240 

L'Aumonier's  Operation,  1782 242 

McDowell  and  Incisionism 243 

The  Long  Incision  of  McDowell 244 

McDowell's  Advance  on  Incisionism 245 

Error  of  McDowell's  Followers 245 

Failure  of  the  Short  Incision 247 

Long  and  Short  Incision  Compared 248 

Typical  Case  Showing  Advantages  of  the  Long  Incision  ...  249 
How   this   Operation    has    been   Studied  and   its   Advantages 

Brought  Out 253 

Immediate  Followers  of  McDowell  in  the  United  States  .     .     .  253 

Attention  Directed  to  Growth  of  Interest 256 

SECTION  I.— OVARIOTOMY  IN  THE  UNITED  STATES. 

Account  of  Three  Cases  of  Extirpation  of  Diseased  Ovaries  by 

Dr.  McDowell 259 

Dr.  Ezra  Michener  of  Philadelphia  Criticises  the  Operation  .     .  262 

Dr.  Henderson  as  a  Defender  of  McDowell 264 

Observations  on  Diseased  Ovaria  by  Dr.  McDowell      ....  267 

Comments  by  Writer 273 

Thirteen  Performances  of  the  Operation  by  McDowell      .     .     .  277 

Ovarian  Operation  by  Dr.  Nathan  Smith  of  Connecticut  .  .  .  284 
Comments  on  Smith's  Operation  by  Drs.  Nathan  R.  Smith  and 

E.  R.  Peaslee 286 

Comments  by  Writer 288 

Alban  G.  Smith's  Case  of  Ovariotomy 294 

R.  D.  Mussey's  Case  of  Ovariotomy 298 

Comments  by  Writer 300 

David  L.  Rogers's  Case  of  Ovariotomy 300 

Comments  by  Writer 302 

Distinctions  in  Ovarian  Tumors  by  Dr.  J.  C.  Warren  ....  303 

Comments  by  Writer 304 

Dr.   Bellinger's  Case    of  Ovarian    Tumor    Complicated    with 

Hydrops  Uteri 305 

Conclusion  of  Comments  by  Writer,  and  Summary      ....  305 


XIV 


CONTENTS. 


SECTION  II.— OVARIOTOMY  IN  FRANCE. 

History  in  France  of  Tapping  and  Incisionism 307 

Lisfranc's  Clinical  Report 308 

Delaporte  and  Extirpation  of  the  Ovary 310 

Old  Procedures  Practised  in  France 311 

Le  Dran  and  Morand,  Memoires  Royal  Academy 312 

Encysted  Dropsy  Treated  by  Le  Dran 313 

Nuck's  Case  of  Abdominal  Tumor 314 

Le  Dran's  Second  Case 316 

Cases  Treated  by  M.  De  La  Chaud  and  Montauiieu     ....  318 

First  Proposal  of  Extirpation  of  a  Dropsical  Ovary       ....  320 

Comments  on  Case  by  M.  Morand 321 

Extirpation  of  Ovary  Suggested  by  Delaporte,  1753      ....  323 

Neglect  of  Subject  from  1807  to  1837 329 

Establishment  of  Drainage  by  M.  Recamier 331 

No  Operation  for  Extirpation  of  Ovary  Performed  in  France  up 

to  1839 331 

Comments  by  Writer 333 

Theden's  Scheme  for  Extirpating  Ovary 342 

L'Aumonier  and  his  Operation 343 

Conclusion  of  Comments  by  Writer 350 

SECTION  III  — OVARIOTOMY  IN  GERMANY. 

Dzondi,  of  Halle,  Association  of  his  Name  with  Ovariotomy     .  351 

Results  obtained  by  Chrysmar,  Dieffenbach  and  Others    .     .     .  353 
Dr.  Chrysmar  the   First  to  Perform   McDowell's   Operation  in 

Germany 354 

Three  Cases  of  Ovariotomy  by  Chrysmar 355 

Dr.  Ehrhartstein.    Synopsis  of  a  Case 357 

On  the  Puncture  and  Extirpation  of  Tumefied  Ovaries      .     .     .  358 

Comments  on  Case  by  Dr.  Dolhoff 361 

Summary  of  Cases  in  Germany 365 

Comments  by  Writer 365 

SECTION  IV  — OVARIOTOMY  IN  GREA  T  BRITAIN 

Antiquity  of  the  Tapping  Operation 377 

Encysted  Dropsy  Recognized 378 

Houston  and  his  Original  Procedure  by  Incision 379 

Incisionism  and  Incisionists 379 

Claims  Affecting  McDowell 380 

Atlee's  Table  of  Ovariotomists,  1701  to  1851 381 

Dr.  Houston's  Case  of  Dropsy  of  the  Left  Ovary 381 

Influence  of  Houston  on  the  Profession  in  France   .....  386 


CONTENTS. 


XV 


PAGE 

Hunter's  Criticism  regarding  Origin  of  Dropsical  Ovaries      .     .  387 

Credit  due  Dr.  Hunter 390 

Influence  of  the  Incisionists  on  Hunter       ........  392 

Lizars's  Observations  on  Extirpation  of  the  Ovaries      ....  395 

False  Diagnosis  and  Unjustifiable  Operation 399 

Instruction  of  Lizars  by  McDowell's  Manuscript 401 

Report  of  Three  Cases  by  Mr.  Lizars .  401 

Criticism  of  Dr.  McDowell  by  Dr.  Johnson 403 

Augustus  Bozzi  (Dr.  A.  B.  Granville).  His  Operations  in  London  408 

Mr.  R.  C.  King,  of  Suffolk.     His  Operations 410 

Mr.  Jeaffreson  and  his  Views 413 

Mr.  W.  J.  West,  of  Tunbridge  Wells,  and  his  Cases    ....  418 

Hargrave's  Case 421 

Guy's  Hospital  Case 421 

Mr.  Crisp's  Case 423 

Mr.  Benjamin  Phillips's  Case 423 

Summary  of  Cases  and  Results  in  Great  Britain       .....  425 

Comments  of  Writer  on  British  Ovariotomy  and  Ovariotomists  425 
General  Summary  of  Cases  and  Results  in  the  United  States  and 

Europe 444 


XV.     Eulogistic  Letters,  etc. 

Letter  from  Sir  T.  Spencer  Wells,  London,  England,  Dated  July 
2, 1887,  Enclosing  Remarks  Relating  to  Ephraim  McDowell, 
M.D.,  made  at  the  "  College  of  Surgeons  "  in  1878     .     .     .     445 

The  Remarks  of  Sir  T.  Spencer  Wells 446 

Letter  from  Dr.  George  Granville  Bantock,  London,  England, 
Expressing  the  Wish  that  a  Grand  Success  will  Crown  the 
Efforts  of  the  Authoress .     449 

Letter  from  Prof.  A.  R.  Simpson,  Edinburgh,  Scotland,  Dated 
October  20,  1887,  to  Dr.  Willoughby  Walling,  United  States 
Consul 450 

Letter  from  Dr.  Willoughby  Walling,  Edinburgh,  Scotland, 
Dated  October  20,  1887,  to  the  Authoress,  Enclosing  Letter 
to  Him  from  Prof.  A.  R.  Simpson 451 

Letter  from  Prof.  A.  R.  Simpson,  Dated  December  6,  1887,  En- 
closing Copy  of  the  Lecture  Delivered  by  Him  at  the  Uni- 
versity of  Edinburgh,  Scotland,  October  19,  1887  ....     452 

The  Lecture  Delivered  by  Prof.  Alexander  Russell  Simpson  .     .     452 

Tribute  to  Dr.  Ephraim  McDowell  by  Prof.  D.  W.  Yandell, 
Delivered  at  a  Complimentary  Dinner  Given  to  Prof. 
Samuel  D.  Gross,  at  Philadelphia,  Pa 460 

Letter  from  Prof.  Walter  Coles,  St.  Louis,  Mo.,  Dated  May, 

1889,  Eulogizing  Dr.  Ephraim  McDowell 463 


XVI 


CONTENTS. 


XVI.  Memorial  Services  at  the  Unveiling  of  the 
McDowell  Monument,  at  Danville,  Ky.,  May 
14,  1879. 

PAGF 

Preface,  by  the  Committee  of  Publication 467 

Letter  from  Dr.  Coleman   Rogers,  Louisville,  Ky.,  Chairman 

Committee  of  Publication 471 

Letter   from   Dr.   L.   S.   McMurtry,  Danville,   Ky.,  Chairman 

McDowell  Monument  Committee 471 

Dedicatory   Address,   by   Professor    Samuel    D.    Gross,   M.D.  472 

Address  of  Professor  Lewis  A.  Sayre,  New  York  City    ....  537 

Letter  from  Dr.  J.  M.  Toner,  Washington,  D.  C 541 

Letter  from  Dr.  Theophilus  Parvin,  Indianapolis,  Ind.      .     .     .  544 

Letter  from  Dr.  T.  G.  Richardson,  New  Orleans,  La 545 

Letter  from  Sir  T.  Spencer  Wells,  London,  England  ....  547 

Letter  from  Dr.  Oliver  Wendell  Holmes,  Boston,  Mass.   .     .     .  548 

Letter  from  Dr.  T.  Gaillard  Thomas,  New  York  City  .  .  .  .  551 
Presentation  Address — Remarks  by  Prof.  Richard  O.  Cowling, 

M.D.,  of  Louisville,  Ky.,  in  Presenting  the  Door-knocker  of 

Dr.  McDowell  to  Professor  Samuel  D.  Gross,  M.D.    .     .     .  553 

Reply  of  Dr.  Gross 557 


ILLUSTRATIONS. 


PAGE 


McDowell,  Ephraim,  M.D.     Portrait     .      Frontispiece. 
Home  and  Office  of  Dr.  Ephraim  McDowell  .     51 

The  First  Ovariotomy 70 

McDowell  Monument,  at  Danville,  Kentucky         .  467 


CHAPTER  I. 


INTRODUCTION. 


In  the  work  now  about  to  be  put  before  the 
public,  it  is  proposed  to  give  a  history  of  the 
late  Dr.  Ephraim  McDowell,  with  a  sketch  of 
his  antecedents,  a  description  of  his  surround- 
ings, a  review  of  the  times  in  which  he  lived, 
together  with  a  treatise  on  ovariotomy,  com- 
paring the  present  mode  of  operating  with 
that  of  eighty  years  ago,  besides  some  interest- 
ing accounts  of  results  that  have  sprung  from 
the  daring  experiments  of  the  frontier  doctor, 
who,  without  anaesthetics,  with  inadequate  in- 
struments and  unskilled  assistants,  conferred 
upon  woman  the  greatest  boon  that  surgery- 
has  ever  given  the  sex. 

The  work  also  contains  letters  and  papers 
from  some  of  the  foremost  American  and  En£- 
lish  surgeons  testifying  to  the  high  place  that 
Dr.  McDowell  holds  in  the  history  of  surgery, 
and  making  clear  his  right  to  be  called  "The 
Father  of  Ovariotomy."  These  papers  are  not 
(O  i 


2  INTRODUCTION. 

only  eulogistic,  but  coming  from  the  highest 
sources  are  equally  instructive. 

The  work  contains  all  that  has  yet  been  dis- 
covered in  the  field  of  ovariotomy,  besides  giving 
the  general  reader  an  interesting  narrative  of 
the  life  and  times  of  one  of  the  most  remarka- 
ble men  of  early  Kentucky.  The  causes  which 
have  led  to  a  great  and  unexpected  scientific 
achievement,  the  conditions  under  which  it  was 
performed,  and  the  character  of  the  man  to 
whom  it  .is  due,  must  always  be  of  interest 
to  those  concerned  in  the  world's  progress. 
Therefore  it  will  be  of  peculiar  interest  to 
note  the  circumstances  under  w*hich  McDowell 
performed  his  first  ovarian  operation,  as  well 
as  to  discover  just  what  manner  of  man  was 
he  whom  his  contemporaries  denounced  as 
little  better  than  a  murderer,  and  who  yet  had 
the  temerity  to  insert  the  knife  into  the  abdo- 
men of  a  woman,  and  to  do  this  again  and 
again. 

In  order  that  his  surroundings  may  be  fully 
depicted,  the  author  has  carefully  gathered  all 
that  has  been  written  about  him,  and  noted 
the  conditions  of  society  at  this  early  date  in 
Kentucky. 

Dr.  McDowell  married  the  daughter  of  Isaac 


INTR  OD  UC  TION.  ■> 

Shelby,  Kentucky's  first  Governor,  and  this 
circumstance  enables  the  writer  to  bring  before 
her  reader  some  most  interesting  reminiscences 
of  the  early  politics  of  the  State,  in  which 
McDowell  played  no  part,  but  which  have  a 
direct  interest  as  showing  the  state  of  the 
times. 

The  material  for  the  work  has  been  collected 
by  a  granddaughter  of  Dr.  McDowell  (Mrs. 
Ridenbaugh),  who,  being  a  descendant  of  these 
two  eminent  men,  Ephraim  McDowell  and  Isaac 
Shelby,  unusual  facilities  have  been  offered  her 
for  making  the  required  investigations.  She 
has  received  the  assistance  of  several  eminent 
physicians  and  surgeons,  the  members  of  the 
fraternity  displaying  warm  interest  and  zeal  in 
aiding  the  production  of  a  fitting  memento  of 
her  grandfather. 

The  great  surgeon  was  born  in  Virginia,  but 
was  brought  by  his  parents  to  Kentucky  when. 
Daniel  Boone  was  still  fighting  the  Indians  on 
"the  dark  and  bloody  ground"  of  Kentucky, 
which  State  was  literally  a  wilderness.  Long 
afterward  it  was  admitted  to  the  Union. 

It  is  not  to  be  supposed  that  it  was  in  the 
wilds  of  the  frontier  that  young  McDowell 
learned  to  use  the  knife  so  skilfully  and  boldly. 


INTRODUCTION. 

Perhaps  it  was  the  pioneer  spirit  which  gave 
him  courage  to  make  the  experiment ;  at  a 
period,  too,  when  it  was  difficult  to  obtain  pro- 
fessional consultation,  as  then  we  had  not  en- 
tered the  progressive  age,  the  age  of  won- 
drously  rapid  development,  when  efforts  to 
girdle  this  microcosm  of  ours  have  been  suc- 
cessfully accomplished  in  sixty-two  days  and  six 
hours. 

Dr.  McDowell  planned  and  put  into  execu- 
tion an  operation  which,  though  successful, 
brought  him,  at  the  hands  of  the  medical  pro- 
fession, vituperation  and  violent  opposition, 
posing  him  before  the  world  as  a  heartless 
"woman-butcher."  Quoting  the  words  of  the 
late  Dr.  W.  L.  Atlee,  "he  had  little  else  than 
the  book  of  nature  before  him,  and  the  con- 
sciousness of  right  to  sustain  him." 

The  twenty-sixth  annual  meeting  of  the 
American  Medical  Association  was  held  in 
Public  Library  Hall,  Louisville,  Kentucky,  on 
May  4,  5,6,  and  7,  1875.  The  Association  was 
called  to  order  by  Dr.  Edward  Richardson,  of 
Louisville,  chairman  of  the  committee  of  ar- 
rangements. 

The  meeting  was  honored  by  the  presence 
of  many  distinguished  gentlemen  from  distant 


JNTR  OD  UCTION.  5 

regions  ;  surgeons  and  physicians  met  for  the 
advancement  of  medical  science  and  for  the 
promotion  of  high  interests  both  as  regards  the 
profession  and  the  community. 

Dr.  Richardson,  in  his  address  of  welcome 
on  this  interesting  occasion,  made  the  following 
allusion  to  some  of  Kentucky's  noblest  sur- 
geons who  have  done  honor  to  the  profession  : 

"It  is  to  us,  Mr.  President,  assembled  as  we 
are,  in  the  presence  of  so  many  eminent  mem- 
bers of  the  profession,  a  source  of  congratula- 
tion that  our  State  is  not  unknown  to  medical 
annals,  and  that  she  may  justly  assert  the  dis- 
tinction of  being  the  first  to  introduce  into  suc- 
cessful practice  several  of  the  most  important 
and  beneficent  operations  of  surgery,  perform- 
ances now  widely  known  and  appreciated,  both 
here  and  in  foreign  lands. 

"The  names  of  McDowell,  of  Bradshear,  of 
Briggs,  of  Dudley,  have,  with  those  of  others, 
been  placed  high  upon  the  roll  of  fame  as 
original  and  independent  thinkers  and  workers 
— men  who  have  deserved  well  of  their  com- 
peers in  the  healing  art ;  and  it  is,  Mr.  Presi- 
dent, a  grateful,  if  it  be  even  but  a  fond  im- 
agination, that  their  revered  shades  are  now 
present  with  us,  to  do  honor  to  this  occasion 


5  INTRODUCTION. 

and  to  enlarge  our  welcome  by  the  addition 
of  their  own.  Nor  would  it  be  improper,  Mr. 
President,  if  our  State  should  institute  also  a 
claim,  or  a  part  at  least,  to  more  than  one  of 
the  distinguished  gentlemen  who  are  now  en- 
rolled as  Eastern  members  of  the  American 
Medical  Association. 

"It  is  probable,  however,  Mr.  President,  that 
the  larger  portion  of  the  membership  of  the 
Association  have  now,  for  the  first  time,  visited 
our  State.  Allow  me  to  say  to  these  that  it  is 
for  the  stranger  that  Kentucky  ever  accords  a 
peculiar  welcome,  and  that  it  is  in  'her  old  Ken- 
tucky home'  that  she  loves  to  dispense  the 
grateful  tribute  due  to  the  eminent  in  science 
and  to  public  benefactors  of  society  who  honor 
her  with  their  presence." 

After  various  papers  had  been  read,  the  res- 
olutions relating  to  the  business  of  the  Asso- 
ciation were  then  taken  up  and  acted  upon. 
Dr.  J.  Marion  Sims,  of  New  York,  read  the 
report  of  the  committee  on  the  "McDowell 
Memorial  Fund,"  which,  on  motion,  was  re- 
ceived, and  the  resolutions  were  unanimously 
adopted.     These  resolutions  were  as  follows  : 

Resolved,  Whereas,  it  is  universally  acknowl- 
edged  that   the    late    Ephraim    McDowell,    of 


INTRODUCTION.  n 

Danville,  Kentucky,  was   the   originator  of  the 
operation  of  Ovariotomy  ;  and 

Whereas,  We  believe  that  proper  measures 
should  be  instituted  to  commemorate  this  great 
achievement,  and  do  appropriate  honor  to  its 
author;  therefore 

Resolved,  That  this  Association  recommends 
to  each  of  its  members,  and  to  the  profession 
generally,  that  contributions  be  made  annually 
of  such  sums  as  may  be  thought  proper  until 
the  amount  of  ten  thousand  dollars  shall  be 
accumulated,  which  money  shall  be  known  as 
the  "McDowell  Memorial  Fund,"  the  interest 
of  it  to  be  devoted  to  payment  of  prizes  for  the 
best  essays  relating  to  the  diseases  and  surgery 
of  the  ovaries. 

Resolved,  That  this  fund  shall  be  invested  by 
trustees  to  be  appointed  by  the  Association, 
and  be  subject  to  such  regulations  as  it  may 
devise. 

Resolved,  That  this  Association  shall  elect  a 
board  of  three  trustees,  whose  duty  it  shall  be 
to  carry  out  the  object  of  these  resolutions, 
and  whose  term  of  office  shall  continue  five 
years. 

Resolved,  That  this  Association  will  leave  to 
the  State  of  Kentucky  the  grateful  privilege  of 


8  INTR  OD  UCTION. 

providing  a  local  memorial  to  the  memory  of 
Dr.  Ephraim  McDowell. 

Respectfully  submitted, 

J.  Marion  Sims,  New  York. 

Washington  L.  Atlee,  Penna. 

W.  H.  Byford.  Illinois. 

J.  M.  Keller,  Kentucky. 

On  motion  of  Dr.  J.  Morris,  of  Maryland,  the 
following  gentlemen  were  appointed  trustees 
of  the  McDowell  Memorial  Fund :  Drs.  Wash- 
ington L.  Atlee,  Pennsylvania;  W.  H.  Byford, 
Illinois ;  J.  M.  Keller  and  John  D.  Jackson, 
Kentucky ;  and  J.  Marion  Sims,  New  York. 

The  following  relates  to  the  first  series  of 
essays  pertaining  to  the  McDowell  Fund,  and 
is  to  have  its  relevancy  understood  later. 

Dr.  L.  P.  Yandell,  chairman  of  Committee  on 
Prize  Essays,  reported  as  follows : 

The  Committee  on  Prize  Essays  beg  leave 
to  report  that  they  have  received  a  number  of 
essays,  carefully  written  and  marked  by  various 
degrees  of  merit.  But  after  as  careful  an  ex- 
amination of  them  as  the  Committee  have  had 
time  to  make,  they  are  not  prepared  to  recom- 
mend any  as  worthy  of  the  prize  offered  by 
the  Association.     One  of  the  papers  submitted 


INTR  OD  UCTION.  g 

to  your  Committee  is  a  work  of  vast  dimen- 
sions. It  makes  four  volumes,  and  an  aggre- 
gate of  more  than  twelve  hundred  pages. 

The  Committee  have  found  it  utterly  imprac- 
ticable in  the  time  at  their  disposal  to  look 
through  this  elaborate  paper.  It  treats  of 
"Excision  of  the  Larger  Joints,"  and  strikes  the 
Committee  as  worthy  of  a  careful  examination. 
They  would,  therefore,  recommend  that  it  be 
submitted  to  a  committee  of  experts,  to  be 
reported  upon  at  the  next  meeting  of  the 
Association.     Respectfully  submitted, 

L.  P.  Yandell, 

Chairman. 

The  report  was  received  and  the  recommen- 
dation adopted.  Drs.  S.  Ashhurst,  S.  D. 
Gross,  and  D.  Hayes  Agnew,  of  Pennsylva- 
nia, were  appointed  as   the  committee. 

Committee  on  Prize  Essays :  Drs.  Samuel 
D.  Gross,  F.  G.  Smith,  Alfred  Stille,  Ellerslie 
Wallace,  and  H.  C.  Wood,  of  Pennsylvania. 

Dr.  John  D.  Jackson,  of  Danville,  Kentucky, 
as  we  see,  was  afterward  appointed  as  one  of 
the  trustees  of  the  McDowell  Memorial  Fund. 
He  attended  the  meeting-  of  the  American 
Medical  Association  at  Detroit,  Michigan,  in 
1874,  and  upon  that  occasion  he  tried  to  im- 


IO  INTRODUCTION. 

press  upon  the  members  of  the  Association  the 
duty  of  the  medical  profession  generally  to 
erect  a  monument,  as  a  fitting  tribute  of  respect 
to  the  illustrious  subject  of  our  memoir,  and 
giving  to  him  the  honor  to  which  he  is  justly 
entitled,  as  the  originator  of  Ovariotomy . 

As  early  as  1872,  Dr.  Jackson  consulted  with 
the  distinguished  Dr.  Lewis  A.  Sayre,  of  New 
York,  as  to  the  propriety  of  erecting  a  monu- 
ment to  the  memory  of  the  late  Dr.  Ephraim 
McDowell.  Dr.  Sayre  urged  him  to  push  the 
matter,  and  said  "  undoubtedly  a  monument 
worthy  so  great  a  man  should  be  erected,  and 
that  he  (Dr.  Sayre)  then  and  there  would 
contribute  liberally  to  such  a  worthy  cause." 

After  several  conversations  with  him  upon 
the  subject,  Dr.  Jackson  returned  to  Kentucky 
fully  determined  in  his  own  mind  to  leave  no 
effort  unmade  to  put  into  execution,  at  no  dis- 
tant day,  the  result  of  his  plans  and  of  conver- 
sations with  Dr.  Sayre  ;  for  after  having  met 
him  he  was  still  more  strongly  impressed  that 
a  monument  should  be  erected. 

About  the  time  that  Dr.  Jackson  thought 
all  the  necessary  arrangements  perfected  to 
carry  out  his  purpose  (and  really  the  cherished 
object  of  his   heart),  he  was  stricken    with  a 


INTRODUCTION.  j  j 

disease  that  has  seldom  yielded  to  man's  skill 
(consumption),  and  in  a  brief  period  passed 
from  his  earthly  labors,  leaving  unfinished,  and 
to  the  hands  of  others,  the  work  in  which  he 
was  so  much  interested.  Dr.  McMurtry,  a 
promising  young  surgeon  at  that  time,  also  of 
Danville,  engaged  at  once  in  the  same  laudable 
undertaking  begun  by  Drs.  Jackson  and  Sayre, 
and  in  a  few  years  thereafter  the  shaft  was 
completed  and  stood  ready  to  be  unveiled; 
which  occasion  we  will  refer  to  in  the  closing 
chapter  of  this  work.  Great  credit  is  due  Dr. 
McMurtry  for  his  perseverance  and  energy  in 
this  matter. 

The  late  Dr.  Jackson,  in  his  remarks  relative 
to  Dr.  McDowell,  seems  to  have  been  im- 
pressed with  the  idea  that  McDowell's  first 
conceptions,  his  first  promptings  to  make  the 
experiment  upon  Mrs.  Crawford,  were  but  the 
teachings  in  embryo  state  of  Mr.  Bell — brought 
out  and  materialized,  as  it  were,  by  McDowell. 

With  all  due  deference  to  the  lamented  Jack- 
son, and  to  his  earnest  convictions,  we  must 
differ  with  him  in  his  views  ;  for  we  are  thor- 
oughly convinced  that  the  idea  of  ovariotomy 
originated  in  the  fertile  brain  of  Dr.  McDowell, 
although  the  words  of  Mr.  Bell  made  a  lasting 


T  2  INTRODUCTION. 

impression  upon  him;  but  he,  McDowell,  lived 
in  an  atmosphere  replete  with  brilliant  achieve- 
ments, generating  and  putting  into  execution 
some  of  the  most  remarkable  surgical  discov- 
eries and  operations  of  any  age — amongst  men 
whose  works  are  blended  with  historical  events 
and  reported  in  our  American  medical  histories. 

It  is  not  surprising,  however,  that  Dr.  Mc- 
Dowell, under  the  immediate  influence  and  dis- 
cipline of  such  an  intellect  as  was  possessed  by 
Mr.  Bell,  should  have  unconsciously  imbibed 
the  spirit  of  his  thoughts  and  suggestions  ;  for 
certainly  the  preceptor  was  a  remarkable  man, 
and,  at  the  time,  in  his  glory.  Ephraim  Mc- 
Dowell studied  under  him  in  1793  and  1794. 

John  Bell  was  tall  and  commanding  in  ap- 
pearance, his  movements  were  quick,  and  his 
speech  the  essence  of  eloquence.  He  was 
nervously  excitable,  and  often  allowed  his  feel- 
ings to  carry  him  further  than  he  wished.  Those 
familiar  with  his  habits  say  that  they  have  often 
seen  him  so  absorbed  in  his  own  ardent  decla- 
mations as  to  deviate  from  the  subject  upon 
which  he  would  be  lecturing. 

He  would  speak  of  some  foreign  subject 
until  his  hour  had  expired,  then  looking  at  his 
watch,   and  realizing  how  ridiculous   he  must 


INTR  OD  UCT10N.  !  3 

have  appeared  to  the  listeners  would  burst  into 
tears. 

He  was  an  experienced,  bold  operator,  and 
understood  the  anatomy  of  the  human  body 
thoroughly. 

He  excelled  all  other  surgeons  in  his  day,  in 
easy  flow  of  language  and  animated  thought. 
His  power  of  description  was  so  great  that  even 
to  the  unprofessional  person  the  reading  of  his 
Anatomy  was  pleasing  and  without  fatigue ;  and 
his  surgery  only  added  interest  and  recrea- 
tion. 

He  gave  himself  great  distinction  by  his 
studies  in  pathology  of  the  arteries  and  by  his 
ingenious  treatment  of  arterial  injuries.  He 
devised  many  new  and  critical  operations,  and 
took  a  keen  interest  in  removing  the  superflui- 
ties of  the  old  surgery,  not  at  all  times  sparing 
the  new. 

Bound  in  the  volume  with  the  Life  of  Dr. 
McDowell  is  a  complete  copy  of  the  memorial 
oration  delivered  by  the  late  S.  D.  Gross, 
M.D.,  LL.D.,  D.C.L.  Oxon.,  at  Danville,  Ken- 
tucky, on  the  occasion  of  the  unveiling  of  the 
monument  erected  to  the  memory  of  Dr.  Mc- 
Dowell, by  the  Kentucky  State  Medical  Society, 
May  14,  1879,  together  with  the  proceedings  of 


!  ^  INTR  OD  UCTION. 

the  Society  relative  to  the  erection  of  the  mon- 
ument, and  papers  read  on  that  occasion. 

The  biography  of  Ephraim  McDowell  will 
interest  every  one  who  takes  a  pride  in  Ameri- 
can thinking,  energy,  and  daring ;  especially 
will  it  appeal  to  scientists — more  than  all,  to 
every  surgeon  and  every  physician.  Although 
the  name  of  "the  father  of  ovariotomy"  is 
familiar  to  all  surgeons,  yet  this  fact  cannot 
lessen  an  interest  that  must  be  felt  in  the  life 
of  Ephraim  McDowell. 


CHAPTER   II. 

ANCESTRAL    LINE    OF    DR.    EPHRAIM    McDOWELL. 

"Of  all  the  fierce  and  warlike  cepts  that 
ranged  themselves  beside  the  Campbells,  under 
the  leadership  of  the  chiefs  of  that  name,  in  the 
struggle  so  replete  with  deeds  of  crime  and 
heroism,  of  oppression  and  stubborn  resistance 
which  had  their  fruit  in  the  overthrow  of  the 
right  line  of  the  Stuarts,  there  were  none  more 
respectable,  nor  none  that  more  perfectly  illus- 
trated the  best  qualities  of  their  race  than  the 
sons  of  Dowall.  Sprung  from  Dougal,  the 
son  of  Ronald,  the  son  of  the  great  and 
famous  Somerled,  they  had,  from  the  misty 
ages,  marched  and  fought  under  the  cloud- 
berry bush,  as  the  badge  of  their  clan,  and  had 
marshalled  under  the  banner  of  the  ancient 
Lords  of  Lorn,  the  chiefs  of  their  race.  The 
form  of  McDowell  was  adopted  by  those  of 
the  McDougal  clan  who  held  lands  in  Gallo- 
way, to  which  they,  the  Black  Gaels,  had 
given  its  name. 

(15) 


j  6  ANCESTRY. 

"The  latter  branch  became  allied  by  blood 
and  intermarriage  with  the  Campbells.  Pres- 
byterians of  the  strictest  sect,  and  deeply 
imbued  with  that  love  of  civil  and  religious 
freedom  which  has  ever  characterized  the  fol- 
lowers of  John  Knox,  they  found  their  natural 
leaders  in  the  house  of  Argyle.  In  what 
degree  related  to  the  chiefs  of  the  name  was 
the  McDowell  who  left  behind  him  the  hills  of 
his  native  Argyleshire,  to  settle  with  others  of 
his  name  and  kindred  and  religion  in  the  north 
of  Ireland  during  the  protectorate  of  Cromwell, 
cannot  be  actually  stated ;  he  was,  so  far  as  can 
be  gleaned  from  vague  traditions,  one  of  the 
most  reputable  of  the  colonists  who  there 
founded  the  race  known  as  the  'Scotch-Irish,' 
the  characteristics  of  which  have  since  been 
so  splendidly  attested  by  its  heroes,  scholars, 
orators,  theologians,  and  statesmen  all  over 
the  world. 

"This  Scotch  colonist,  McDowell,  had  among 
other  children  a  son  named  Ephraim,  which  of 
itself  indicates  that  he  was  a  child  of  the  Cove- 
nant. It  was  fitting  that  Ephraim  McDowell 
should  become  at  the  early  age  of  sixteen  years 
one  of  the  '  Scotch-Irish '  Presbyterians  who 
flew  to  the  defence  of  heroic  Londonderry  on 


ANCESTR  Y.  Ty 

the  approach  of  McDonnell,  of  Antrim,  on  the 
9th  of  December,  1688,  and  that  he  should  be 
one  of  the  band  who  closed  the  gates  against 
the  native  Irishry  intent  on  blood  and  rapine. 
During  the  long  siege  that  followed,  the 
memory  of  which  will  ever  bid  defiance  to  the 
effacing  hand  of  time,  and  in  which  the  devoted 
preacher  George  Walker  and  the  brave  Murray 
at  the  head  of  their  undisciplined  fellow-citizens 
— farmers,  shopkeepers,  mechanics,  and  ap- 
prentices— but  Protestants,  Presbyterians,  suc- 
cessfully repelled  the  assaults  of  Rosen,  Mar- 
mont,  Persignan,  and  Hamilton,  the  McDowell 
was  conspicuous  for  endurance  and  bravery  in 
a  land  where  all  were  brave  as  the  most  heroic 
Greek  who  fell  at  Thermopylae. 

"The  maiden  name  of  the  woman  who  be- 
came the  worthy  helpmate  of  the  Londonderry 
soldier-boy  was  Margaret  Irvine,  his  own  full 
cousin.  She  was  a  member  of  an  honorable 
Scotch  family  who  settled  in  Ireland  at  the  same 
time  as  their  kinspeople,  the  McDowells.  The 
names  of  Irvin,  Irvine,  Irving,  Irwin,  and  Er- 
win  are  identical — those  bearing  the  name 
thus  variously  spelled  being  branches  from  the 
same  tree.  The  name  was  and  is  one  of  note 
in  Scotland,  where  those  who  bore  it  had  inter- 


!  8  .  ANCESTR  Y. 

married  with  the  most  prominent  families  of 
the  kingdom,  breeding  races  of  soldiers,  states- 
men, orators,  and  divines. 

"Ephraim  McDowell  who  fought  at  Boyne 
River,  as  well  as  at  Londonderry,  was  already 
an  elderly  man  when,  with  his  two  sons  John 
and  James,  his  daughters  Mary  and  Margaret, 
and  numerous  kinsmen  and  co-religionists,  he 
emigrated  to  America  to  build  for  himself  and 
his  a  new  home.  In  his  interesting  Sketches 
of  Virginia,  Foote  states  that  he  was  accom- 
panied to  Virginia  by  his  wife,  and  that  his  son 
John  was  a  widower  when  he  left  Ireland  ;  but, 
as  in  the  deposition  of  Mrs.  Mary  E.  Green- 
lee, the  daughter  of  Ephraim,  her  father,  her 
brother  John,  her  husband,  and  herself  are 
designated  as  composing  the  party  emigrating 
to  Virginia  from  Pennsylvania,  and  no  mention 
is  anywhere  made  of  her  mother,  Mr.  Foote 
is  probably  in  error,  and  the  uniform  tradition 
of  the  family  is  more  likely  to  be  correct — that 
the  wife  of  Ephraim  McDowell  died  in  Ireland, 
and  that  John  McDowell  had  never  been  mar- 
ried until  he  came  to  America. 

"The  exact  date  of  his  arrival  in  Pennsyl- 
vania is  not  known.  The  journal  of  Charles 
Clinton — the  founder  of  the  historic  family  of 


ANCESTRY.  jq 

that  name  in  New  York — gives  an  account  of 
his  voyage  from  the  county  Longford,  in  the 
good  ship  'George  and  Ann,'  in  company  with 
the  'John  of  Dublin,'  having  many  McDowells 
aboard  as  his  fellow-passengers.  The  '  George 
and  Ann'  set  sail  on  the  9th  of  May,  1729. 
On  the  8th  of  June  a  child  of  James  McDowell 
died,  and  was  thrown  overboard  ;  several  other 
children  of  the  same  family  afterward  died  ; 
also  a  John  McDowell,  and  the  sister,  brother, 
and  wife  of  Andrew  McDowell.  The  ship 
reached  land  on  the  coast  of  Pennsylvania  on 
the  4th  day  of  September,  1729.  Whether  or 
not  the  conjecture  that  Ephraim  McDowell 
was  a  passenger  with  his  kindred  on  board  this 
ship  at  that  time  is  correct,  it  is  certain  that 
about  the  same  time  he  and  his  family  and 
numerous  other  McDowells,  Irvings,  Camp- 
bells, McElroys,  and  Mitchells,  came  over 
together  and  settled  in  the  same  Pennsylvania 
county. 

"In  Pennsylvania  Ephraim  McDowell  re- 
mained several  years.  There  his  son  John  was 
married  to  Magdelena  Wood,  whose  mother 
was  a  Campbell,  and,  as  tradition  has  it,  of  the 
noble  family  of  Argyle.  There  Samuel  (the 
father  of  Dr.  Ephraim  McDowell  the  subject 


20  ANCESTR  Y. 

of  this  work)  the  eldest  son  of  John  and  Mag- 
dalena  McDowell,  was  born  in  1735.  There 
too,  probably,  Mary,  the  daughter  of  Ephraim, 
met,  was  beloved  by,  and  married  James 
Greenlee,  a  Presbyterian  Irishman,  of  English 
descent,  and  said  to  have  been  remotely  de- 
scended from  the  Argyle-Campbells. 

"Some  years  before,  a  near  relative  of  Eph- 
raim McDowell,  by  name  John  Lewis,  had  left 
Ireland  a  fugitive.  Sir  Mungo  Campbell,  an 
oppressive  landlord,  had  attempted  in  a  lawless 
and  brutal  manner  to  evict  him  from  premises 
of  which  he  had  a  freehold  lease,  had  slain 
before  his  eyes  an  invalid  brother,  and  with 
one  of  his  cruel  henchmen  had  died  the  death 
of  the  unrighteous  beneath  the  strong  hand  of 
Lewis.  First  seeking  refuge  in  Portugal,  where 
lived  a  brother  of  his  wife,  he  was  by  him 
advised  to  find  a  safer  asylum  in  the  great  cen- 
tral valley  of  Pennsylvania,  whither  were  then 
flocking  many  of  the  Protestants  of  Ulster. 
His  first  resting-place  was  at  Lancaster,  where 
he  was  in  time  joined  by  his  sons  Samuel,  Tho- 
mas, and  Andrew,  and  by  his  noble  wife  Mar- 
garet Lynn.  The  latter  was  a  native  of  Ire- 
land. Her  ancestors,  the  chiefs  of  their  clan, 
derived  their   patronymic    from    the    beautiful 


ANCESTR  Y. 


21 


loch  on  whose  banks  in  Scotland  nestled  their 
homes,  and  in  the  mountains,  reflected  by  the 
translucent  waters  of  which,  they  hunted.  He 
landed  in  Pennsylvania  the  same  year  that 
brought  the  McDowells  to  America — 1729. 
That  John  Lewis  and  Ephraim  McDowell  were 
related  and  had  been  friends  in  Ireland,  ap- 
pears from  the  deposition  of  Mrs.  Mary 
Greenlee,  the  daughter  of  the  latter,  in  1806  in 
the  suit  of  Joseph  Burden  vs.  Alex.  Cueton 
and  others.  The  degree  of  the  kinship  is  not 
stated ;  but  from  the  similarity  of  Christian 
names  in  the  two  families,  and  other  circum- 
stances, it  is  believed  their  mothers  were 
sisters. 

" James  McDowell,  the  second  son  of  the 
Londonderry  soldier,  had  planted  corn  and 
made  a  settlement  on  the  South  River,  in  the 
Beverly  Manor,  in  the  spring  of  1737  ;  and 
thither  the  remaining  members  of  the  family 
determined  to  proceed  and  pitch  their  tents. 
Accordingly,  in  the  fall  of  the  year,  Ephraim 
and  John  McDowell  and  James  and  Mary 
Greenlee  left  Pennsylvania,  traversed  the  lower 
valley  of  the  Shenandoah,  intending  to  locate 
not  far  from  John  Lewis,  and  had  reached 
Sewell's    creek,  where    they  went   into   camp. 


22 


ANCESTR  Y. 


The  fires  were  lighted  and  arrangements  made 
for  the  evening  meal,  when  a  weary  stranger 
coming  up  solicited  their  hospitality.  It  was  Ben- 
jamin Burden  (or  Borden  as  the  name  is  spelt  by 
those  of  the  family  who  clung  to  New  Jersey, 
and  gave  its  designation  to  Bordentown),  an 
Englishman  who  had  recently  come  over  as 
the  agent  of  Lord  Fairfax,  the  proprietor  of 
the  Northern  Neck.  Meeting  at  Williams- 
town  with  John  Lewis  in  1736,  he  had 
accepted  the  cordial  invitation  of  the  latter 
to  visit  him  at  Bellefonte,  Pennsylvania,  had 
chased  the  roaming  buffalo  with  the  hos- 
pitable Irishman  and  his  stalwart  sons,  and 
with  their  assistance  had  taken  a  buffalo 
calf,  which,  carrying  as  a  trophy  to  Williams- 
burg, he  presented  to  Governor  Gooch. 
Pleased  with  what  was  then  a  curiosity  in  tide- 
water Virginia,  and  anxious,  besides,  to  pro- 
mote the  extension  of  the  frontier  and  the 
settlement  of  hardy  pioneers,  as  a  means  of 
protection  and  defence  to  the  more  populous 
lower  country,  Sir  William  issued  to  Burden  a 
patent  for  500,000  acres  of.  land  or  any  less 
quantity,  situated  on  the  Shenandoah  or  James 
River,  not  interfering  with  previous  grants,  on 
condition  that,  within  ten  years,  he  should  set- 


ANCESTRY.  2\ 

tie  on  the  lands  so  located  not  less  than  one 
hundred  families ;  one  thousand  acres  for  every 
family  settled  or  cabin  built,  with  the  privilege 
of  purchasing-  an  additional  adjacent  one  thou- 
sand acres,  at  one  shilling  per  acre.  Making 
himself  known  to  the  McDowells,  and  produc- 
ing the  patents  as  proof  of  his  rights,  he  in- 
formed them  that  he  had  located  ten  thousand 
acres  in  the  forks  of  the  James  River,  to  which 
he  could  not  find  his  way,  and  stated  he  would 
give  one  thousand  acres  to  any  one  who  would 
pilot  him  to  his  possessions. 

"John  McDowell  was  a  man  of  education, 
and  a  practical  and  skilful  surveyor.  He 
accepted  Burden's  proposition  ;  writings  were 
entered  into  to  complete  the  agreement,  and 
finally  the  party  agreed  to  settle  in  '  Burden's 
Grant'  and  to  assist  him  in  conforming  to  its 
conditions.  The  next  day  proceeding  to  John 
Lewis'  and  remaining  there  a  few  days  until 
all  the  stipulations  of  the  contract  could  be 
reduced  to  writing,  they  went  on  until  coming 
to  the  lands  upon  which  Burden  had  the  privi- 
lege to  enter,  building  their  cabins  in  what  is 
now  Rockbridge  County,  not  far  from  the  pres- 
ent town    of   Lexington — Ephraim  and   John 


24  ANCESTR  V. 

McDowell  and  James  Greenlee,  the  first  three 
settlers  in  all  that  region. 

" Complying  with  their  agreement  with  Bur- 
den, they  immediately  entered  into  communi- 
cation and  opened  negotiations  with  their 
kindred  friends,  and  co-religionists  in  Pennsyl- 
vania, Ireland,  and  Scotland ;  soon  drawing 
around  them  other  Scotch  and  Scotch-Irish 
families — McClungs,  McCues,  McCowns,  Mc- 
Elroys,  McKees,  McCampbells,  McPheeters, 
Campbells,  Stuarts,  Paxtons,  Syles,  Irvines, 
Caldwells,  Calhouns,  Alexanders,  Cloyds — 
names  which  since  have  gloriously  illustrated 
every  page  of  Western  and  Southern  history. 
In  the  field,  at  the  bar,  in  the  pulpit,  in  the 
Senate,  on  the  bench,  on  the  hustings,  every- 
where by  their  courage,  eloquence,  learning, 
and  patriotism,  they  have  made  themselves 
conspicuous  ;  making  famous  their  own  names, 
and  building  up  the  country  with  whose  history 
and  growth  they  are  inseparably  identified. 

"Burden  lived  on  the  grant  until  near  the 
time  of  his  death  in  1742.  Having,  through 
the  McDowells,  fulfilled  the  conditions  of  the 
'grant,'  Burden  induced  his  son-in-law,  James 
Patton,  to  seek  an  increase  of  fortune  in  the 
new  world. 


ANCESTRY.  2$ 

"Remarkable  in  many  ways,  other  than  the 
great  age  of  more  than  a  century  to  which  he 
lived,  the  span  of  Ephraim  McDowell's  life 
covered  the  overthrow  of  the  Stuarts,  the  rise 
of  the  House  of  Hanover,  the  establishment  of 
the  Empire  of  Britain  in  India  and  over  the 
seas,  the  wresting  of  New  York  from  the 
Dutch,  and  the  expulsion  of  the  French  from 
North  America  ;  the  erection  of  the  electorate 
of  Brandenburg  into  the  kingdom  of  Prussia  ; 
the  victories  of  Marlborough  and  Eugene,  of 
the  great  Frederick,  the  consolidation  of  the 
Russian  Empire  under  Peter  and  his  succes- 
sors, the  opening  of  the  great  West  by  the 
daring  pioneers,  and  the  growth  of  liberalism 
in  Great  Britain,  France,  and  America. 

"Foremost  by  reason  of  influence  and 
energy  of  the  virtuous  and  hardy  community, 
he  and  his  associates  erected  school-houses 
and  churches  in  the  valley  even  before  they 
constructed  forts.  Eminently  useful  and  prac- 
tical in  the  character  of  his  mind  and  the  man- 
ner of  his  life,  Howe  records  the  fact  that  he 
built  the  first  road  across  the  Blue  Ridge,  to 
connect  the  valley  with  the  tidewater  country, 
at  once  affording-  a  mode  of  egress  for  the 
production    of    the    former,    and    facilities   for 


26  ANCESTRY. 

receiving  from  the  merchants  of  the  latter  the 
manufactures  of  the  old  world.  Religious, 
moral,  intelligent,  and  shrewd,  the  singular 
and  beneficent  influence  he  acquired  among 
the  independent  and  intrepid  spirits  by  whom 
he  was  surrounded,  was  a  natural  tribute  to 
his  virtue  and  sagacity,  and  to  the  unflinching 
devotion  to  the  cause  of  civil  and  religious 
liberty  he  had  all  his  life  upheld. 

"It  is  scarcely  necessary  to  state  of  such  a 
man,  at  once  hospitable  and  provident,  that  he 
failed  not  to  use  the  opportunities  with  which 
fair  and  generous  nature  had  surrounded  him 
to  reap  and  store  a  fortune  considered  very 
large  in  those  days.  Retaining  full  possession 
of  all  his  faculties  to  the  very  last,  he  died  not 
until  the  outbreak  of  the  Revolutionary  war, 
and  not  until  he  had  heard  praises  bestowed 
on  his  grandchildren  for  good  conduct  shown 
at  the  battle  of  Point  Pleasant."1 

John  McDowell,  the  father  of  Samuel  Mc- 
Dowell, fell  in  battle  with  the  Indians,  in  the 
year  1 743.  He  commanded  a  company  of  brave 
men,  who  fought  the  savages  desperately,  but 
were  compelled  to   retreat,  when   the  Indians 

1  Historic  Families  of  Kentucky. 


ANCESTRY.  27 

massacred  the  leader  and  eight  of  his  men. 
The  survivors,  being  completely  routed, 
escaped  as  best  they  could. 

Rev.  W.  W.  Foote,  in  his  interesting 
Sketches  of  Virginia,   says  : 

"The  burial  place  of  these  men,  the  first 
perhaps  of  Saxon  race  ever  committed  to  the 
dust  in  Rockbridge  County,  you  may  find  in  a 
brick  enclosure  on  the  west  side  of  the  road 
from  Staunton  to  Lexington,  near  the  red 
house  or  'Maryland  Tavern,'  formerly  the  resi- 
dence of  John  McDowell.  Entering  the  iron 
gate  and  inclining  to  the  left  about  fifteen 
paces,  you  will  find  a  low,  unhewn  limestone 
tomb,  about  two  feet  in  height,  on  which,  in 
rude  letters,  by  an  unknown,  unpractised  hand, 
is  the  following  crude  inscription  : 

Heer  lyes 
the  boddy  of  John  Mack 

Dowell. 
died. 

December — 1743.     " 

John  McDowell  left  three  children,  Samuel, 
James,  and  Sarah.  James  remained  in  Virginia, 
consequently  inheriting  a  handsome  estate. 
He  married  Miss  Sarah  Preston,  whose  family 
were    closely    identified   with  the    interests   of 


28  ANCESTRY. 

Virginia.  Three  children  were  born  to  them. 
The  second  daughter  married  Col.  Thomas  H. 
Benton,  a  once  prominent  politician.  He  was 
several  times  United  States  Senator,  and  was 
for  many  years  identified  with  Missouri's  inter- 
ests and  politics. 

Samuel  McDowell,  the  first-born  of  John 
(and  grandson  of  old  Ephraim,  of  London- 
derry), and  the  father  of  Dr.  Ephraim  Mc- 
Dowell, the  subject  of  this  work,  was  born  in 
the  colony  of  Pennsylvania,  October  29,  1735. 
On  the  17th  day  of  January,  1754,  in  Rock- 
bridge County,  Virginia,  at  the  age  of  eighteen 
years,  he  was  married  to  Miss  Mary  McClung, 
daughter  of  John  McClung  and  Elizabeth  Alex- 
ander, the  lady  being  born  in  Ireland,  October 
28,  1735,  and  being  by  one  day  the  senior  of 
her  husband.  She,  Elizabeth  Alexander,  was 
the  daughter  of  Archibald  Alexander  and  Mar- 
garet Parks,  and  was  born  at  "Manor  Cunning- 
ham," Scotland,  and  was  married  in  Ireland, 
December  31,    1734. 

Samuel  McDowell  and  his  wife  Mary  had 
eleven  children  born  to  them,  and  Ephraim 
was  the  ninth  child.  For  many  years  Judge 
Samuel  McDowell  was  engaged  in  public  life, 
and   held  many  high  positions  of  trust.     He 


ANCESTR  Y.  20 

served  six  different  times  as  chairman  of  the 
State  Convention  before  the  election  of  a  Gov- 
ernor. He  was  a  member  of  the  legislature 
several  terms.  He  was  colonel  of  a  regiment 
in  the  battle  of  Guildeford,  North  Carolina.  He 
was  the  first  United  States  judge  for  Kentucky, 
and  was  president  of  the  convention  which 
framed  the  constitution  of  that  State  in  1792. 
When  Spain  opened  negotiations  with  Ken- 
tucky to  have  that  State  declare  its  indepen- 
dence, he  was  an  active  worker  and  prominent 
politician.  In  the  year  1782  he  was  appointed 
by  the  Virginia  Assembly  a  land  commissioner. 
In  1784,  many  flattering  inducements  being 
offered  him,  he  removed  with  his  family  to 
what  is  now  known  as  Mercer  County,  Ken- 
tucky; and  in  1786  he  was  one  of  the  presiding 
judges  at  the  first  county  court  held  in  that 
State,  the  Kentucky  District.  From  that  date 
he  was  given  the  title  of  Judge,  and  was  always 
known  afterward  as  Judge  Samuel  McDowell. 

In  the  year  1785  he  was  chosen  to  preside 
over  the  convention  which  met  in  the  rural 
village  of  Danville,  then  the  county  seat  of  Mer- 
cer County,  Kentucky  ;  he  was  likewise  chosen 
to  preside  over  all  the  subsequent  conven- 
tions which  assembled  to  discuss  the  means  of 


30  ANCESTRY. 

attaining  an  end  so  commonly  desired.  His 
irreproachable  character,  his  judicial  temper, 
his  solid  attainments,  and  matured  convictions 
possessed  him  of  the  universal  confidence.  He 
was  admirably  qualified  for  the  position  that 
his  destiny  allotted  him  to  fill,  and  it  was  by  the 
patient  discretion  and  calm,  considerate  judg- 
ment of  the  presiding  officer,  and  the  deter- 
mined, cool  patriotism  of  others  like  himself, 
that  the  difficulties  of  a  separation  from  Vir- 
ginia were  peacefully  and  legally  overcome, 
and  the  numerous  advantages  commercially 
— the  unobstructed  and  free  navigation  of 
the  Mississippi — eventually  and  satisfactorily 
reached.  In  the  unsettled  and  perilous  times 
connected  with  the  early  history  of  the  West, 
and  especially  with  pioneer  life  in  the  State  of 
Kentucky,  he  was  the  "  central  figure  of  an 
historical  group  of  men  conspicuous,  like  him- 
self, for  courage,  intelligence,  fortitude,  endur- 
ance, dignity  of  character,  and  mental  poise. 
All  were  representative  men,  were  types  of  a 
cultivated  class  and  of  a  vigorous,  aggressive, 
and  enduring  race."1 

Judge  McDowell  was  appointed  aid-de-camp 
by  old  "King's  Mountain"  Shelby,  by  whose 

1    Vide  The  Genesis  of  a  Pioneer  Commonwealth. 


ANCESTRY.  ,  I 

side  he  had  fought  at  Point  Pleasant.  He  was 
also  commissioned  by  General  Washington, 
under  whose  eye  he  had  served  in  the  campaign 
on  the  Monongahela  in  1755,  and  who  well 
knew  his  worth.  In  every  position  he  honorably 
acquitted  himself.  Years  afterward  a  singular 
coincidence  occurred  in  his  family — the  marriage 
of  his  son  Ephraim  to  the  daughter  of  "King's 
Mountain"  Shelby.  The  official  records  also 
show  that  Judge  McDowell  commanded  a  com- 
pany of  scouts,  that  he  was  a  gallant  and  brave 
officer,  and  that  he  did  valuable  service  during 
that  memorable  campaign  in  which  the  power 
of  the  Shawanese  was  broken. 

After  many  years  of  useful  service  to  his 
country,  an  honored  and  respected  citizen,  es- 
teemed for  his  strong  sense,  for  an  integrity 
that  never  succumbed,  for  an  unassailable  pri- 
vate as  well  as  public  life,  he  lived  beyond  his 
three  score  years  and  ten  ;  lived  to  serve  and 
bless  the  God  of  his  creation  ;  and  as  he  lived  a 
Christian  life,  so  he  died  triumphant  in  his  faith, 
expecting  to  receive  the  inheritance  promised 
through  the  Holy  Prophets.  He  calmly  and 
peacefully  passed  away  September  25,  18 17, 
at  the  ripe  age  of  eighty-two  years,  at 
the    residence    of    his    son,     Colonel    Joseph 


32  ANCESTRY. 

McDowell,  whose  home  was  near  Danville, 
Kentucky. 

We  herewith  note  the  children  of  this  re- 
markable pioneer : 

Their  first-born  "Magdaline  McDowell,''  was 
the  twin  to  Sarah  McDowell.  The  children 
were  born  October  9,  1755.  Magdaline  was 
married  to  Andrew  Reid,  and  Sarah  married 
Caleb  Wallace. 

John  McDowell  was  born  December  8,  1757. 
He  married  his  cousin,  Sarah  McDowell.  He 
was  an  officer  in  the  Revolutionary  war. 

James  McDowell  was  born  April  29,  1760, 
and  married  Mary  Lee,  of  Virginia.  He  also 
served  in  the  Revolutionary  war,  and  was 
colonel  in  the  war  of  18 12.  He  fought  in 
various  Indian  conflicts  and  wars  of  Gov- 
ernor Scott's  and  Hopkin's  campaign. 

William  McDowell  was  born  March  19, 
1762.  He  married  Margaret  Madison,  a  cou- 
sin of  President  Madison,  and  sister  of  Gover- 
nor Madison. 

Samuel  McDowell  was  born  March  8,  1764. 
Married  Annie  Irvine.  He  filled  with  honor 
the  position  as  first  United  States  Marshal  in 
the  State  of  Kentucky. 

Martha  McDowell  was  born  June  26,  1766. 


ANCESTRY. 


33 


She  married  Colonel  Abram  Buford,  a  daring, 
courageous  Revolutionary  officer. 

Joseph  McDowell  was  born  September  13, 
1768.  He  was  an  officer  in  the  war  of  181 2, 
and  Adjutant-General  in  Governor  Isaac  Shel- 
by's army  in  Canada. 

Ephraim  McDowell,  justly  entitled  "the 
father  of  ovariotomy,"  was  born  November  11, 
1 77 1.  He  married  Sarah  Shelby,  the  daughter 
of  Governor  Isaac  Shelby,  of  whom  we  will 
speak  more  hereafter. 

Mary  McDowell  was  born  January  11,  1774. 
Her  marvellous  beauty  gave  her  great  reputa- 
tion ;  her  gentle,  amiable  manners  won  her 
hosts  of  friends  ;  and  her  Christian  character 
illumined  her  pathway  of  life.  She  married 
Alexander  Keith  Marshall,  brother  to  John 
Marshall,  Chief  Justice  of  the  United  States. 

Caleb  McDowell,  the  youngest  child,  was 
born  April  17,  1776.  He  married  his  relative, 
Betsy  McDowell,  daughter  of  Major  Joseph 
McDowell,  of  North  Carolina. 


CHAPTER  III. 

EARLY    LIFE    OF    EPHRAIM    MCDOWELL   AND    HIS 
EDUCATIONAL   ADVANTAGES. 

When  Ephraim  McDowell  was  only  thirteen 
years  of  age,  he  came  with  his  father  from 
Rockbridge  County,  Virginia  (the  place  of  his 
nativity),  to  Danville,  Kentucky.  The  party 
experienced  many  long  days  of  perilous  travel, 
and  were  subjected  to  privations  that  the 
youth  of  the  present  period  would  shrink  from 
encountering ;  but  this  brave  and  courageous 
boy  kept  a  stout  heart  and  not  a  murmur  es- 
caped his  lips.  He  had  unbounded  confidence 
in  his  father's  judgment,  and  felt  that  whatever 
modification  of  his  life  was  to  come  out  of 
the  change  being  made  must  result  in  his  good 
and  aggrandizement. 

Even  at  that  tender  age  he  displayed  both 
unusual  judgment  and  wonderful  reasoning 
power.  His  youthful  mind  contrasted  in  its 
development  favorably  with  those  of  much 
greater    maturity.       He    was    thoughtful    and 

(34) 


EARLY  LIFE.  35 

studious,  and  it  was  frequently  remarked  by 
members  of  his  family,  and  those  interested 
in  his  welfare,  that  when  his  schoolmates  and 
associates  would  call  for  him  to  accompany 
them  to  their  playground,  he  would  frequently 
decline,  resisting  their  persuasions  and  return- 
ing to  his  books  and  studies — displaying  at 
once  that  indomitable  will  over  the  desire  of 
the  heart :  for  what  boy  is  there  that  does  not 
enjoy  the  freedom  from  school  halls  and  per- 
plexing studies  ?  He  realized,  even  at  this 
early  age,  that  he  had  a  higher  purpose  in  life 
than  personal  pleasure,  that  he  had  a  mind 
to  store  with  well-trained  thoughts,  and  that 
the  body  was  simply  the  servant  to  the  will. 
He  early  received  a  religious  training,  and  as 
soon  as  he  could  lisp  the  name  of  God  was 
taught  to  reverence  the  word,  and  never  to  use 
it  idly  or  in  vain.  Hence,  with  such  parents 
to  mould  his  character,  to  bend  the  twig  as  it 
should  be  bent,  to  guide  his  footsteps  through 
life's  thorny  pathway,  cold  and  perverse  would 
have  been  his  heart  had  it  denied  such  holy 
impressions  or  not  have  been  influenced  and 
elevated  by  them. 

After   traversing   the  vast   wilderness,  with 
here  and  there  occasionally  a  hewn-log  cabin 


36 


EARL  Y  LIFE. 


seen  peering  above  the  heavy  undergrowth, 
nothing  of  interest  occurring  to  dispel  the  lone- 
liness of  the  solitary  journey,  they  reached,  in 
due  course  of  time,  the  small  village  of  Dan- 
ville, at  that  time  the  seat  of  the  most  refined 
and  cultured  society  in  that  far  western  land. 
The  surrounding  country  presented  an  inviting 
appearance.  The  soil  was  loamy  and  friable. 
Clear  and  rippling  brooks  meandered  through 
the  timbers,  making  a  natural  irrigation  that 
offered  fine  inducements  to  the  agriculturist, 
who  saw  the  advantages  immediately  derived 
from  such  soil,  and  grasped  the  opportunity  of 
cultivating  the  same  by  permanently  locating 
with  their  families  in  such  a  country. 

After  Samuel  McDowell  settled  with  his 
family  in  Danville,  he  induced  many  of  his 
friends  to  leave  Virginia  and  come  to  Ken- 
tucky. Even  before  the  sturdy  citizens  engaged 
in  business  or  farming,  they  organized  to 
establish  schools  and  churches,  that  their  chil- 
dren might  not  waste  their  precious  time. 
They  formed  resolutions  among  themselves  to 
this  effect:  "Many  of  us,  and  our  forefathers 
left  our  native  land  and  explored  this  once 
savage  wilderness,  to  enjoy  the  free  exercise 
of  the  rights  of  conscience  and  of  human  na- 


EARL  Y  LIFE.  37 

ture.  These  rights  we  are  fully  resolved,  with 
our  lives  and  our  fortunes,  inviolably  to  pre- 
serve. Nor  will  we  surrender  such  estimable 
blessings,  the  purchase  of  toil  and  danger,  to 
any  ministry,  to  any  parliament,  or  any  other 
body  of  men  upon  earth,  by  whom  we  are  not 
represented,  and  in  whose  decision  we  have 
no  voice." 

Such  resolutions  our  forefathers  framed,  and 
strictly  adhering  to  them,  made  for  themselves 
happy  homes  and  a  prosperous  country. 

Ephraim  McDowell  developed  early  into  a 
tall,  erect,  and  commanding  figure.  He  was 
considered  strikingly  handsome,  having  lustrous 
black  eyes  that  seemed  to  penetrate  into  the 
very  thoughts  of  those  who  looked  into  them. 
His  refinement  and  intellectual  powers  were  of 
the  highest  type,  and  his  friends  predicted  for 
him  a  brilliant  career  in  whatever  profession 
he  chose  to  follow.  Young  as  he  was,  he 
had  an  inquisitive  mind,  searching  for  new 
truths  ;  and  to  attain  these  he  was  a  constant 
reader.  He  seemed  possessed  with  wonderful 
magnetism,  and  his  ardent  temperament  won 
him  some  lasting  friends,  which  he  retained  to 
the  time  of  his  death.  He  was  a  fine  conver- 
sationalist, and  his  ready  wit  was  most  pleasing. 


28  EARLY  LIFE. 

He  enjoyed  a  good  joke,  and  took  great  pleas- 
ure in  perpetrating  innocent  pranks  upon  his 
friends.  The  profession  of  medicine  was  his 
own  choice,  and  he  was  especially  fond  of  the 
literature  pertaining  to  surgery. 

He  received  his  early  education  at  the  classi- 
cal seminary  of  Messrs.  Worley  and  James, 
who  first  taught  at  Georgetown,  Kentucky,  and 
afterward  at  Bardstown  in  the  same  State.  He 
then  went  to  Virginia  and  entered  the  office  of 
Dr.  Humphrey,  of  Staunton,  as  a  medical  stu- 
dent, where  he  remained  for  two  or  three  years, 
closely  applying  himself  to  his  studies. 

We  know  but  little  of  this  Dr.  Humphrey, 
save  that  he  was  a  graduate  of  the  University 
of  Edinburgh,  and  in  his  day  enjoyed  a  consid- 
erable local  reputation  and  an  extensive  prac- 
tice in  Staunton  and  its  vicinity.  The  fact  of 
his  being  a  good  instructor  is  highly  probable. 
Another  of  his  pupils,  Dr.  Samuel  Brown,  was 
one  of  the  founders  and  one  of  the  first  corps 
of  lecturers  of  the  medical  department  of 
"Transylvania  University"  of  Lexington,  Ken- 
tucky, and  rose  to  high  distinction. 

In  the  years  1793  and  1794,  Ephraim  at- 
tended lectures  at  the  University  of  Edinburgh, 
Scotland,  contemporaneously  with  his  country- 


EARL  Y  LIFE.  39 

men,  Drs.  Samuel  Brown  (before  alluded  to), 
Hosack,  and  Davadge,  of  New  York,  also  Dr. 
Brackenborough,  of  Virginia,  all  of  whom  sub- 
sequently attained  eminence  in  the  profession. 

While  in  attendance  on  the  course  of  the 
University,  he  also  took  the  private  course  of 
John  Bell,  who  at  that  time  was  not  a  member 
of  the  faculty,  and  it  would  appear  that  the  bril- 
liant prelections  of  this  most  able,  eloquent,  and 
gifted  of  the  Scotch  surgeons  of  that  day  must 
have  impressed  him  profoundly.  That  portion 
of  his  course  in  which  he  lectured  on  the 
diseases  of  the  ovaries,  dwelling  on  the  inevit- 
able death  to  which  the  victims  were  doomed, 
and  merely  suggesting  the  possibility  of  suc- 
cess attending  any  operation  that  might  be  at- 
tempted for  removal  of  the  organs,  was  certainly 
never  forgotten  by  his  auditor,  for  he  carefully 
stored  in  his  mind  the  principles  and  sugges- 
tions at  this  time  enunciated  by  the  Master, 
together  with  other  impressions,  which  sixteen 
years  later  determined  him  to  attempt  his  first 
ovariotomy,  which  operation  has  immortalized 
him,  and  opened  to  the  broad  field  of  surgery 
the  abdominal  operations ;  and  from  that  distant 
day.  (now  eighty  years  ago)  to  the  present  time, 
countless  thousands  can  testify  to  their  being 


40  EARL  Y  LIFE. 

relieved  and  saved  by  the  bold  and  daring-  ope- 
ration which  he  gave  to  the  medical  world. 

Through  the  kindness  of  Col.  J.  McD.  Alex- 
ander, of  Virginia,  we  have  been  furnished  with 
and  are  indebted  to  him  for  the  following  in- 
teresting letters,  not  interesting  for  their  anti- 
quity alone,  but  as  conveying  an  idea  of  the 
political  condition  of  the  country  at  that  early 
period  when  our  forefathers  were  struggling 
for  their  rights.  These  letters  were  addressed 
to  Ephraim  McDowell  during  the  time  that  he 
attended  lectures  at  Edinburgh,  and  were  writ- 
ten to  him  by  his  father  and  by  Mr.  Reid,  his 
brother-in-law. 

Mercer  County,  State  of  Kentucky, 
February  io,  1793. 

Dear  Ephraim  :  I  have  not  heard  from  you 
since  you  left  Rockbridge,  and  am  very  anxious 
to  hear  of  your  safe  arrival  in  Scotland.  I  can 
with  pleasure  inform  you  that  myself  and  all 
your  friends  in  Kentucky  are  well,  for  which 
we  have  reason  to  be  thankful  to  the  great 
Author  of  our  Being.  We  have  not  anything 
worth  communicating  since  I  wrote  you  last, 
when  you  were  in  Rockbridge.  Our  new  gov- 
ernment seems  to  go  on  middling  well,  but 
our  legislature  seems  very  parsimonious.    They 


EARLY  LIFE.  4I 

have  given  our  government  ^300  a  year,  and 
the  judges  of  the  Court  of  Appeals  ^200.  The 
secretary  £100  and  the  auditor  ^100.  The 
treasurer  ^100,  and  the  judges  of  the  court  of 
Oyer  and  Terminer  £30,  but  it  is  supposed 
that  they  will  increase  the  salaries  at  their  next 
meeting ;  but  I  rather  think  they  will  not,  as 
it  [is]  popularity  the  most  of  the  members  are 
seeking,  and  not  to  do  right  if  they  even  knew 
it.  The  seat  of  government  is  fixed  at  Frank- 
fort, Kentucky,  on  the  Kentucky  River,  where 
I  have  got  a  lot  or  two,  one  of  which  is  for 
you,  if  you  live  to  return,  and  choose  to  come 
to  Kentucky,  which  I  wish  you  to  do. 

I  would  be  glad  to  hear  how  you  like  your 
situation  there,  and  how  long  you  think  it  will 
be  necessary  for  you  to  stay,  for  I  assure  you 
it  will  be  very  hard  for  me  to  send  you  a 
supply  of  money.  But  I  will  endeavor  to  sup- 
port you  if  in  my  power,  and  to  enable  you  to 
bring  with  you  some  books,  and  a  quantity  of 
medicine  to  serve  you  some  time,  and  to  set 
up  a  decent  shop.  But  I  fear  I  will  not  be  able 
to  send  you  money  sufficient.  But  if  you  had 
it  in  your  power  to  get  credit  for  some  of  which 
you  might  think  would  be  necessary,  I  will,  I 
hope,  be  able  in  a  short  time  after  your  return, 


a  2  EARL  Y  LIFE. 

to  make  a  remittance  to  pay  for  the  medicine. 
Is  there  no  person  trading  to  Scotland  to  whom 
you  could  apply  ? 

But  I  need  say  no  more  on  the  subject  for  it 
is  not  to  be  expected  that  any  person  there 
could  place  so  much  confidence  in  you  as  to 
give  you  credit  for  one  hundred  pounds  worth 
of  books  and  medicine,  and  you  must  try  to  do 
the  best  you  can,  and  steward  well  the  little 
money  you  took  with  you.  I  may  be  able  to 
send  you  some,  which  may  be  about  fifty 
pounds.  I  will  send  you  more  if  you  need  it, 
and  it  will  be  in  my  power. 

Give  my  best  compliments  to  Mr.  Brown 
and  Mr.  Watkins.  Tell  Mr.  Brown  his  brother 
James  is  well ;  also  tell  Mr.  Watkins  I  saw  his 
father  not  long  since,  who  was  well  and  had 
got  a  letter  from  him.  Your  mother  seems  to 
think  much  and  longs  to  see  you  once  more  in 
Kentucky.  You  know  of  my  small  misfortune 
in  my  speaking.  I  am  almost  now  persuaded 
that  what  Dr.  Humphreys  said  is  the  case 
(to-wit),  a  swelling  in  the  glands  about  the  root 
of  the  tongue,  as  sometimes,  especially  in  the 
morning,  you  would  not  observe  it  'to  hurt  my 
speaking  and  I  feel  no  difficulty,  and  after 
some  time  in  the  day  it  grows  worse.     Try  and 


EARL  Y  LIFE.  43 

find  out  if  any  such  case  happens  in  the  course 
of  your  business  that  you  may  help  me.  Let 
it  be  the  swelling  of  the  glands,  or  what  I  sus- 
pected, a  touch  of  the  palsy,  I  only  add  my  best 
wishes  for  your  happiness,  and  believe  me  to 
be  your  affectionate  father, 

Samuel  McDowell. 

N.  B. — Your  mother  sends  her  blessings  to 
you  and  hopes  you  will  not  forget  your  duty  to 
God,  who  has  always  been  so  kind  to  you. 

Direction  : 

Mr.  Ephraim  McDowell,  Student, 

Edinburgh, 

Scotland. 
Care  of  Col.  Gamble, 

Richmond. 

Letter  to  Ephraim  McDowell  from  his 
brother-in-law,  A.  Reid,  of  Rockbridge  County, 
Virginia.  Note  the  length  of  time  it  required 
for  letters  to  reach  America  a  century  ago, 
when  they  were  written  from  Europe ;  Ephraim 
McDowell's  letter  bearing  date  of  March  4, 
1793,  and  the  reply  being  written  immediately 
upon  receipt  of  Ephraim's  letter,  August  25, 
1793- 


44 


EARL  Y  LIFE. 


Rockbridge,  Virginia, 
August  25,  1793. 


Dear  Ephraim  :  I  have  just  received  yours 
dated  March  4th  last,  by  which  I  was  agreeably 
informed  of  your  safe  arrival  at  Edinburgh. 
The  opportunity  you  had  of  seeing  so  much  of 
that  old  and  well-cultivated  country,  must  have 
been  very  agreeable.  I  hope  it  has  and  will 
ease  your  mind  on  that  score  until  you  com- 
plete your  studies. 

I  hope  you  will  not  take  it  amiss  of  a  friend, 
to  repeat  the  necessity  of  your  diligence. 

Your  father  has,  I  expect,  written  you  that 
he  means  to  furnish  you  with  ^300,  including 
what  you  took  with  you  from  home  ;  which, 
from  the  statement  in  your  letter  of  the  neces- 
sary expenses,  I  am  afraid  will  scarcely  be  suf- 
ficient without  very  great  economy. 

I  have  had  letters  from  Kentucky  lately; 
your  friends  are  all  well  there.  Indians  are 
still  very  troublesome  on  the  frontiers  from 
North  to  South.  A  treaty  has  been  proposed 
by  the  government,  I  suppose  more  with  a  view 
of  quieting  the  minds  of  members  who  are 
averse  to  the  war,  than  an  expectation  of  peace. 
By  every  act  the  Indians  refuse  treating  on  any 
other  terms  than  making  the  Ohio  River  the 


EARL  Y  LIFE.  45 

line,  which  never  will  be  complied  with  by  the 
Government.  The  President1  has  called  on 
the  State  of  Kentucky  for  fifteen  hundred  vol- 
unteers. It  is  said  they  (with  a  considerable 
addition)  will  march  about  the  first  of  next 
month.  Report  says  that  the  commissioners 
who  were  sent  to  treat  with  the  Indians  are 
made  prisoners  and  not  permitted  to  return. 

We  have  agreeable  news  from  France  lately. 
It  is  said  they  have  beat  the  combined  armies, 
both  by  sea  and  land,  and  I  hope  will  continue 
to  do  so  until  their  freedom  is  established ; 
should  the  reverse  take  place  the  consequences 
might  be  of  a  serious  nature  to  America. 
There  is  scarcely  a  doubt  that  the  combined 
powers  would  attempt  to  suppress  republican- 
ism here. 

Your  brother  Caleb  came  in  about  the  first 
of  March  ;  he  will  stay  with  me  perhaps  three 
years  or  better  to  learn  the  business  of  the 
office.  When  you  return  will  expect  you  to 
take  Rockbridge  in  your  road  to  Kentucky. 
Dr.  Falconer  left  Lexington  in  the  spring  and 
returned  to  the  State  of  New  Jersey.  He  sold 
out  his  shop  of  medicine  to  Dr.  Campbell,  who 

1  General  Washing-ton. 


46 


EARL  Y  LIFE. 


succeeded  him  in  the  practice  and  is  in  pretty 
good  esteem.  Dr.  Falconer  is  expected  every 
day  to  return.  He  intended  settling  in  Buck- 
ingham County  on  the  James  River. 

In  addition  to  the  medical  faculty  at  Staunton, 
there  is  a  Dr.  Mcintosh,  who  by  a  pompous 
advertisement,  offers  his  services,  and  in  order 
to  introduce  himself  he  says  he  studied  at 
Edinburgh  and  attended  the  lectures  of  Mr. 
Monroe.  Your  sister,  Caleb,  Sallie,  and  the 
rest  of  the  family  join  me  in  compliments  to 
you.  I  am,  dear  Ephraim,  respectively  your 
friend  and  brother,  A.  Reid. 

Ephraim  McDowell, 

Edinburgh,  Scotland,   1793,  A.  D. 

The  following  letter  was  written  by  Judge 
Samuel  McDowell  (father  of  Ephraim)  to  his 
son-in-law,  Mr.  Andrew  Reid,  of  Virginia: 

Mercer  County,  July  11,  1792. 

Dear  Sir  :  I  have  nothing  worth  notice  to 
tell  you,  only  that  it  gives  us  sorrow  to  part 
with  Sally,  but  as  you  expressed  a  desire  that 
she  should  come  home,  Joseph  thought  as 
Ephraim  was  amind  to  go  to  Europe  next  fall, 
he  might  as  well  go  now  and  see  him  before 
he  went  way.     I  had  it  not  in  my  power  to  do 


EARL  Y  LIFE.  47 

anything  with  the  sheriff  about  your  fees.  I 
have  talked  to  them,  and  none  of  them  have 
collected  them ;  they  say  the  people  against 
whom  they  are  cannot  pay  as  they  are  mostly 
very  poor. 

Whenever  the  courts  begin  to  do  business,  I 
will  move  against  all  the  sheriffs  who  have  any 
of  them,  but  I  really  fear  little  of  them  will  ever 
be  collected.  Benton  declares  he  will  pay  off 
the  balance  that  he  owes  by  Christmas  next, 
he  has  paid  me  about  ^"6o ;  very  little  of  it  in 
money,  some  cows,  pork,  and  orders  on  other 
people  who  have  not  yet  paid.  I  think  the 
whole  I  have  paid  you  is  £$0.  A  civil  list 
warrant  by  Joseph,  fifteen  pounds  to  Ligert,  by 
your  order,  and  six  pounds  for  the  land  war- 
rants. I  sent  you  in  all  ^51.  I  expect  to  set- 
tle with  Benton  before  long  and  know  the 
exact  amount  he  has  paid,  and  will  then  let  you 
know  how  much  is  in  my  hands,  and  in  the 
meantime  if  you  get  any  money  from  Evens  or 
Fritte  make  use  of  it  till  I  send  you  Benton's 
whole  money  or  state  his  account  to  you. 

Joseph  can  tell  you  some  of  the  proceedings 
of  our  Assembly.  The  revenue  law  taxes  land 
at  two  shillings  the  hundred  acres,  and  all 
people  claiming  land  here  must  make  return  of 


48 


EARL  Y  LIFE. 


it  to  the  commissioner  by  February  9,  1795,  or 
loose  the  land.  I  have  not  seen  any  of  their 
laws — they  are  not  printed,  but  Joseph  can  tell 
you  something  of  several  of  them.  I  have  not 
as  much  money  as  I  intended  to  send  by  Eph- 
raim  when  he  goes  ;  but  perhaps  he  may  have 
enough  'till  I  can  send  him  a  supply  again;  he 
will  perhaps  have  upwards  of  ^200,  and  I 
wished  him  to  have  ^250.  But  I  think  he  had 
not  better  carry  it  in  money,  as  there  may  be 
danger  of  losing  it,  but  take  a  bill  on  some  good 
man  in  Edinborough  or  Glascow ;  but  if  that 
should  be  protested  it  would  be  bad  for  Eph- 
raim.  I  can  say  nothing  on  the  subject,  you 
and  him  must  do  as  you  find  it  best.  I  leave 
the  whole  direction  to  you,  and  I  hope  he  will 
act  prudently. 

If  you  have  any  doubt  of  his  economy  or 
prudence  pray  let  me  know,  for  I  would  not  be. 
for  his  going  to  Scotland,  if  he  was  of  an  im- 
prudent behavior  in  any  respect  whatever.  I 
could  wish  to  establish  some  way  of  sending 
him  any  little  supplys  from  Richmond  ;  you  and 
Joseph  may  lay  some  plan  perhaps.  Mr.  Sin- 
clair can  give  you  some  assistance  in  fixing  the 
matter.  If  Colonel  Gamble  lives  in  Richmond 
perhaps  he  may  be  a  friend  in  the  matter.    But 


EARL  Y  LIFE.  4g 

I  am  too  far  from  the  scene  of  action  to  o-ive 
any  direction  in  the  matter. 

I  could  wish  you  were  here  this  fall,  as  there 
will  be  a  number  of  clerks  places  to  fill,  and  I 
believe  you  could  get  the  first  clerkship  in  the 
county,  that  is  to  the  Court  of  Appeals.  But 
I  would  not  wish  to  advise  you  to  anything  of 
that  kind,  least  you  should  be  disappointed. 
But  I  am  fully  of  opinion  it  might  be  better  for 
your  prosperity  that  you  were  living  here. 

Are  the  people  in  and  about  Lexington  as 
religious  as  they  were  some  time  ago  ?  My 
dear  sir,  religion  is  a  most  excellent  thing,  and 
that  we  should  be  all  earnest  to  obtain,  but 
the  zeal  of  some  of  the  Lexingtonians  goes 
wild  or  carries  them  to  extravagances  and 
folly  ;  that  is,  in  my  opinion,  very  foreign  to 
true  religion  ;  and  will  have  a  tendency  to  make 
them  people  very  proud  and  unsocial,  looking 
upon  all  who  are  acting  like  rational  creatures 
to  be  the  wicked  ones  on  earth,  and  look  down 
on  them  with  contempt.  I  am  persuaded  that 
the  way  them  people  (or  some  of  them)  are 
acting,  will  inevitably  lead  to  a  savage  or 
superstitious  state  in  the  course  of  one  or  two 
hundred  years — perhaps  in  much  less  time. 
Those  good  people  will   not  associate  with  the 

4 


5o 


EARL  Y  LIFE. 


wicked  (as  they  call  them)  but  meet  only  for 
religious  worship  or  socially  with  their  religious 
friends.  Had  that  been  the  case  formerly  we 
had  yet  been  in  ignorance,  but  mankind  mixing 
in  assemblys  for  innocent  amusement,  culti- 
vates friendship  and  civilizes  the  world.  It 
makes  their  manners  more  mild  and  friendly 
and  removes  that  sourness  that  superstition 
and  bigotry  leaves  on  the  mind.  May  you  and 
me,  my  dear  sir,  be  earnest  to  live  in  this  world 
as  not  to  give  offense  to  any  one,  and  still  act 
like  rational  creatures ;  for  I  am  persuaded 
that  the  Divine  Being  cannot  delight  to  see  his 
creatures,  that  he  has  endowed  with  rational 
power,  lay  aside  their  reasoning  powers  and 
give  themselves  up  to  superstition. 

Give  my  love  to  Magdaline  and  your  dear 
little  family,  and  believe  me  to  be  with  extreme 
affection,  dear  sir, 

Your  affectionate  father, 

Samuel  McDowell. 

Mr.  A.  Reid, 

Rockbridge,  Va.,  1792,  A.  D. 


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CHAPTER   IV. 

RETURN    FROM    EDINBURGH. 

Upon  his  return  to  Danville,  in  the  year 
1795,  McDowell  entered  at  once  on  the  prac- 
tice of  his  profession.  Commencing  as  he  did 
with  the  eclat  of  an  attendance  upon  the  then 
most  famous  medical  school  of  the  world  (for 
at  that  time  Edinburgh  held  the  position  since 
occupied  by  Paris,  and  more  recently  by  Vienna, 
as  the  centre  of  medical  science),  he  soon  as- 
sumed the  first  professional  position  in  the 
community  in  which  he  lived,  not  uninterfered 
with,  however,  by  envy  and  jealousy.  His  fel- 
low professors  of  medicine  and  surgery,  aspiring, 
with  himself,  to  fame  and  distinction,  regarded 
McDowell's  superior  medical  advantages  with 
a  jealous  eye,  as  was  proven  by  many  acts  and 
words  of  covert  nature. 

Dr.  McDowell  made  a  speedy  advance,  his 
reputation  extending,  within  a  few  years, 
throughout  the  entire  Western  and  Southern 
country,  all  this  wide  region  accepting  him  as 

(51) 


c  2  #E  TURN  FR  OM  EDINB  UR  GH. 

the  first  and  leading  surgeon  west  of  Philadel- 
phia. 

Of  Kentucky  citizens  of  the  preceding  gen- 
eration, many  obtained  distinction  in  their 
respective  pursuits,  but  it  is  doubtful  if  any  of 
them  builded  so  deeply  the  foundation  of  an 
enduring  fame  as  did  Ephraim  McDowell,  of 
Danville.  While  others  wielded  great  powers, 
and  rendered  various  services  in  their  day  and 
generation,  Dr.  McDowell  inaugurated  a  work 
which  continues  to  live  and  grow  after  the 
originator  has  passed  from  the  scenes  of  his 
labors. 

By  his  originality,  skill,  and  courage,  he 
opened  up  a  new  departure  in  the  science  and 
practice  of  surgery  which  has  advanced  until 
now  accepted  as  being  not  wide  of  the  crowning 
glory  of  this  great  and  beneficent  art.  Through 
this  departure  thousands  of  women  have  been 
rescued  from  certain  and  painful  death.  By 
his  own  hand  he  demonstrated  the  practicability 
of  the  new  work  his  genius  had  devised,  and  he 
published  the  results  of  his  labors.  The  crea- 
tion was  complete  in  execution  as  well  as  in 
priority.  He  is  recognized  throughout  the  civ- 
ilized world  as  the  originator  of  a  great  depart- 
ment of  surgical  practice  and  as  a  benefactor 


RE  TURN  FR  OM  EDINB  UR  GH.  5  3 

to  his  race.  His  name  is  familiar  to  the  stu- 
dents of  medical  science  in  every  land  and 
clime,  forming,  in  the  language  of  Fitz-Greene 
Halleck,  one  of  the  few,  the  immortal  names 
that  were  not  born  to  die.  In  every  land  the 
practitioner  of  surgery  is  utilizing  amid  the 
brilliant  achievements  of  his  art,  and  his  efforts 
toward  the  restoration  of  life  and  health,  the 
results  of  McDowell's  work.  In  the  rapid  pro- 
gress of  science,  other  hands  and  minds  have 
now  widened  the  scope  and  extended  the  appli- 
cation of  his  great  operation,  yet  this  but  adds 
to  the  grandeur  of  the  original  step,  and  lends 
additional  lustre  to  the  fame  of  him  who  led  the 
way. 

With  the  exception  of  J.  Marion  Sims,  a 
native  of  South  Carolina,  no  physician  on  this 
continent  has  contributed  such  far-reaching 
and  potential  influence  toward  advancing  and 
enriching  the  resources  of  surgical  science. 
Indeed  these  two  great  American  surgeons 
founded  the  modern  science  of  gynecology, 
which  has  brought  to  American  medicine  and 
American  physicians  so  much  of  the  renown 
and  esteem  in  which  they  are  regarded  in  all 
foreign  countries. 

Since  the  early  history  of  the  commonwealth, 


54  RE  TURN  FR  OM  EDINB  UR  GH. 

the  medical  profession  of  Kentucky  has  ranked 
alongside  the  most  advanced  of  the  entire 
country,  and  within  her  borders  was  estab- 
lished one  of  the  oldest  and  most  renowned  of 
America's  medical  schools.  But  great  discov- 
eries springing  from  that  wonderful  creative 
faculty  which  utilizes  all  previous  research  in 
conception,  and  combines  skill,  courage,  and 
intelligent  penetration  qf  undiscovered  lines  of 
thought  in  execution,  are  uncommon  in  all 
branches  of  learning.  To  rend  the  veil  which 
conceals  the  mysteries  of  science  is  allowed  to 
comparatively  few,  but  such  privilege  fell  to  the 
lot  of  Ephraim  McDowell.1 

As  has  been  previously  stated,  McDowell 
came  fresh  from  the  University  of  Edinburgh, 
and  selected  as  his  future  home  Danville,  Ken- 
tucky, a  small  rural  village  composed  of  an 
aristocratic  little  colony,  where  he  soon  dis- 
played such  talent  as  a  surgeon  and  physi- 
cian, that  it  was  not  long  before  he  divided 
honors  with  the  great  men  of  the  State,  espe- 
cially those  of  Lexington  City ;  and  while,  at  the 
latter  point,  the  enterprising  founders  of  what 
was  soon  to  be  the  first  great  medical  school 

1  See   Butler's    History    of  Kentucky,  written    in   the  year 
1834. 


RE  TURN  FR  OM  EDINB  UR  GH.  r  r 

of  the  West  were  busying  themselves  with 
schemes  for  the  permanent  establishment  of 
Transylvania  University,  Ephraim  McDowell, 
at  Danville,  laid  the  foundation  for  a  great 
revolution  in  the  "ars  chirurmae." 

While  measures  were  being  consummated 
for  laying  a  surgical  foundation  that  would  not 
crumble  and  fall  by  Time's  blighting  hand, 
plans  for  future  personal  comfort  and  happi- 
ness were  also  being  weighed  and  stored  in 
his  well-balanced  mind.  He  was  thoroughly 
domestic  in  his  habits  and  tastes,  and  admired 
the  pure  and  ennobling  characteristics  of  a 
good  and  elevated  woman.  At  the  age  of  thirty- 
one  years  he  decided  to  select  a  suitable  help- 
mate and  companion  for  life. 

Having  met  Miss  Sarah  Shelby,  the  daughter 
of  his  father's  tried  and  trusted  friend  (Gover- 
nor Isaac  Shelby),  his  heart  quickly  became 
deeply  interested  in  her,  while  his  attentions, 
marked  from  the  first,  soon  culminated  in  vows 
of  love,  which  love,  happily  for  him,  was  ar- 
dently reciprocated.  In  the  year  1802  the  two 
were  married  at  the  home  of  the  bride's  parents 
a  few  miles  distant  from  Danville. 

Miss  Shelby  was  the  highest  type  of  a 
noble  Christian   woman,  and  certainly  a.  most 


c  6  RE  TURN  FR  OM  EDINB  UR  GH. 

suitable  person  to  be  the  wife  of  Ephraim  Mc- 
Dowell. She  was  remarkable  for  her  intelli- 
gence and  keen  perceptive  powers.  Her 
strength  of  character,  sound  common  sense 
and  domestic  qualities,  combined  with  a  lovable 
disposition,  won  for  her  the  admiration  and 
encomiums  of  those  who  were  fortunate  enough 
to  know  her.  She  was  also  gifted  as  a  writer, 
and  many  beautiful  and  original  thoughts 
emanated  from  her  well-stored  mind.  She 
could  never  be  induced,  however,  to  give  to  the 
public  any  of  her  writings,  though  numerous 
pages  of  manuscript  were  stored  away  ;  her 
most  choice  and  original  pages  being  carried 
to  the  garret,  to  moulder,  and  finally  pass  out 
of  existence.  In  appearance  Miss  Shelby  was 
graceful  and  of  commanding  height.  She  was 
dignified  and  reserved  in  manner,  although  her 
brilliant  flashes  of  wit  and  innocent  double 
entendre  were  not  unfreely  furnished  the  social 
circle  in  which  she  moved.  Her  tastes  were  of 
that  elevated,  refined  nature  that  makes  woman 
most  attractive.  Although  but  eighteen  years 
of  age  at  the  time  of  her  marriage,  she  pos- 
sessed a  mind  matured  and  observing  to  a 
degree  that  reflected  large  credit  on  her  mater- 
nal rearing.    She  was  a  devoted  member  of  the 


RETURN  FROM  EDINBURGH.  57 

Episcopal  Church,  and,  believing  that  a  true 
Christian  should  rise  above  the  petty  annoy- 
ances incident  to  the  daily  life  of  all,  she  verified 
her  faith  by  acts  of  devotion.  Her  influence 
over  her  husband  was  so  great  that  shortly 
after  marriage  he  connected  himself  with  the 
church,  remaining  a  faithful  and  zealous  member 
until  the  time  of  his  death. 

The  present  site  upon  which  Christ  Church 
in  Danville  stands,  was  a  donation  from  him. 
He  was  also  an  especial  friend  to  "Centre  Col- 
lege," cooperating  largely  toward  its  founda- 
tion both  by  his  influence  and  liberal  donations 
of  money.  He  was,  indeed,  one  of  its  original 
corporators  and  curators.  This,  too,  although 
its  government  was  by  the  Presbyterian  Church. 
He  was  a  man  of  liberal  views,  neither  bigoted 
nor  sectarian.  He  saw  and  appreciated  the 
enjoyment  and  happiness  derived  from  leading 
a  religious  life. 

He  was  fond  of  books,  and  at  the  time  of 
his  death  possessed  an  excellent  library  for 
the  period  in  which  he  lived.  He  constantly 
made  additions  to  his  medical  works,  and 
whenever  a  new  book  of  merit  was  issued  he 
would  invariably  purchase  it.  The  iron  grasp 
of  progress  had  a  firm  hold  on  him  and  would 


c  3  RE  TURN  FR  OM  EDINB  UR  GH. 

not  relax  its  grip  until  he  had  arrived  at  the 
pinnacle  of  fame  and  achieved  the  earnest 
desire  of  his  heart. 

He  had  a  fair  knowledge  of  the  classics,  yet 
he  gave  most  of  his  leisure  time  to  belles-lettres 
and  history,  both  of  which  he  was  very  fond  of 
studying.  He  also  gave  much  and  earnest  at- 
tention to  biology. 

When  leisure  hours  allowed  opportunity  he 
would  take  long  strolls  through  beautiful  wood- 
lands convenient  to  his  home.  In  one  of  these 
walks  accompanied  by  his  wife,  he  discovered 
lying  upon  the  sand,  bordering  a  clear  stream 
of  water  which  meandered  through  his  farm,  a 
number  of  small  pale  blue  eggs,  resembling 
those  of  some  diminutive  bird.  The  two  gath- 
ered these  and  supposing  them  to  be  bird's 
eggs,  carried  them  to  their  home,  placing  them 
in  a  saucer  in  a  warm,  dark  closet.  Hav- 
ing occasion  to  punish  one  of  his  grandsons, 
he  could  think  of  nothing  more  severe  for 
the  disobedient  little  fellow  than  to  lock  him 
up  in  this  closet  for  a  little  time.  The  boy 
had  not  been  confined  in  his  prison  but  a 
few  moments,  when  he  screamed  dreadfully, 
at  the  same  time  frantically  calling  out,  "  Oh ! 
let  me  out,  grandpa ;  there  is  something  crawl- 


RE  TURN  FR  OM  EDINB  UR  GH.  5  g 

ing  all  over  me  ;  please  let  me  out.  I  will  be 
good."  The  doting  grandparent  could  not 
resist  the  entreaties  of  the  terrified  child,  and 
on  unlocking  the  door,  imagine  his  horror  and 
surprise  to  find  the  closet  swarming  with  young 
snakes,  every  egg  having  hatched  out.  Fortu- 
nately, nothing-  worse  came  of  the  incident  than 
the  sad  fright  experienced  by  the  child.  The 
grandfather  never  again,  however,  attempted 
to  punish  his  little  grandson. 

Dr.  McDowell  was  a  man  of  the  tenderest 
emotions  and  sympathies.  His  manner  was 
plain  and  unassuming.  He  invariably  dressed 
in  black,  adhering  closely  to  the  silk  stock  and 
ruffled  linen.  He  was  scrupulously  neat  in  his 
person. 

He  did  not  use  tobacco  in  any  form,  and 
often  expressed  himself  as  having  a  disgust  for 
a  man  that  chewed.  Although  strictly  temper- 
ate, he  would  occasionally  take  a  small  drink  of 
whiskey  or  cherry  bounce  (the  latter  his  favor- 
ite beverage)  when  he  had  experienced  any 
unusual  exposure.  He  always  kept  the  finest 
drinks  upon  his  sideboard  for  the  pleasure  of 
his  guests  and  friends. 

He  employed  an  overseer  to  manage  his 
farm,  and  taking  a  deep  interest  in  raising  fine 


go  RE  TURN  FR  OM  EDINB  UR  GH. 

horses  and  swine,  he  closely  observed  the  man- 
ner of  rearing  and  fattening-  them.  It  was  from 
a  familiar  process  in  this  connection  that  he 
gathered  important  facts,  which  resulted  in  his 
experiment  upon  Mrs.  Crawford. 

Being  of  Scotch  extraction,  it  would  naturally 
be  inferred  that  the  gifted  Burns  was  a  favorite 
with  him,  and  from  his  familiarity  with  the  Scot- 
tish dialect,  acquired  while  in  Edinburgh,  his 
readings  and  quotations  were  given  with  idiom 
as  perfect  as  if  he  had  been  a  native  of  old 
"Kee  Kee." 

Six  children  were  born  to  Ephraim  and 
Sarah  McDowell.  Their  first-born,  "Shelby," 
was  a  bright  and  promising  boy ;  unfortunately, 
in  the  absence  of  his  father,  he  inhaled  a  wheat 
spear  into  his  windpipe,  and  expired  before 
medical  aid  could  reach  him. 

The  second  son,  "Wallace,"  a  gentle,  quiet, 
and  greatly  beloved  son,  lived  to  attain  man- 
hood and  married  Miss  Mary  Hall.  For  several 
years  he  was  engaged  in  mercantile  pursuits, 
and  was  esteemed  an  upright  and  conscien- 
tious business  man.  A  singular  fact  worthy  to 
be  noticed,  was  that  Wallace  McDowell  could 
not  look  at  the  blood  of  any  animal  without 
fainting.     It  was  evident  that  he  was  not  born 


RE  TURN  FR  OM  EDINB  UR  GH.  5  ! 

to  be  a  surgeon.  He  lived  to  rear  a  family  of 
children,  dying-  only  a  few  years  back  in  Mis- 
souri. 

Susan  McDowell,  the  eldest  daughter,  mar- 
ried Colonel  David  Irvine,  of  Richmond,  Ken- 
tucky. She  died  leaving  four  children.  Mary 
their  second  daughter,  married  her  cousin  once 
removed,  George  Young,  a  wealthy  and  pros- 
perous farmer  of  Shelby  County,  Kentucky. 

Mary  McDowell,  not  unlike  her  aunt,  and 
bearing  the  same  name,  was  a  marvellously 
handsome  woman  ;  indeed,  her  blended  beauty 
of  face,  form,  and  character,  gave  her  both 
enviable  reputation  and  celebrity.  The  sweet 
and  fascinating  expression  of  her  face  was  but 
the  reflection  of  a  mind  stored  with  choice 
knowledge,  while  her  character  was  resplend- 
ent with  deeds  of  mercy,  love,  and  charity. 
The  poor  idolized  her,  for  during  her  brief  ex- 
istence (having  died  at  thirty  years  of  age) 
she  had  proved  herself  a  friend  to  them  by  her 
many  acts  of  benevolence.  She  left  four  small 
children  ;  they  never  knew  the  depth  of  such  a 
mother's  love. 

Adaline  McDowell,  the  third  daughter,  mar- 
ried a  prominent  politician,  Judge  James  Deade- 
rick,   of   Tennessee.     She    was    an    unusually 


62  RE  TURN  FR  OM  EDINB  UR  GH. 

bright  and  clever  woman,  kind  and  lovely  in 
disposition.     She  still  survives. 

Catharine,  the  fourth  and  youngest  child, 
married  Colonel  A.  A.  Andison,  of  Tennessee. 
She  also  survives  her  parents,  and  has  lived  to 
see  her  children  grown. 

The  father  of  Mrs.  McDowell,  Governor 
Isaac  Shelby,  of  "King's  Mountain"  fame,  was 
one  of  the  most  prominent  and  influential  citi- 
zens in  the  State  of  Kentucky.  Emigrating  at 
an  early  day  to  that  vast  wilderness  and  be- 
coming closely  identified  with  the  interests  of 
the  country,  by  the  provisions  of  the  Constitu- 
tional Convention  at  Danville,  Kentucky,  on 
the  fourth  day  of  June,  1792,  he  was  chosen 
Governor  of  the  State  ;  on  the  sixth  day  of  the 
succeeding  May  he  met  in  person  and  addressed 
the  Legislature  after  the  custom  of  the  British 
monarchs,  which  custom  was  imitated  by  many 
Governors  and  by  President  Washington.1  He 
served  in  the  Revolutionary  war  with  honor 
and  distinction.  He  planned  and  was  second  in 
command  at  the  battle  of  "King's  Mountain," 
where  one  thousand  British  prisoners  were  cap- 
tured, and  for  his  chivalry  and  daring  deeds  he 
was  awarded  by  the  Congress  of  the  United 

1  See  History  of  Kentucky. 


RE  TURN  FR  OM  EDINB  UR  GH.  £  3 

States  a  handsome  gold  medal,  now  in  the  pos- 
session of  the  State  of  Kentucky,  and  cared  for 
at  Frankfort,  the  Capitol.  His  son  presented 
this  medal  to  the  State  as  a  relic  of  meritorious 
antiquity. 

His  election  to  the  chief  magistracy  was  an 
act  of  wisdom  on  the  part  of  the  common- 
wealth, then  in  its  infancy.  As  an  individual 
he  sympathized  with  the  project  of  opening  the 
Mississippi  River  to  free  navigation,  yet  he 
held  himself  ready,  not  only  to  enforce  the  laws 
of  Kentucky,  but  to  perform  whatever  was 
constitutionally  required  of  him,  as  Governor, 
by  the  President  of  the  United  States.  His 
letter  to  General  Washington  is  admirable  in 
its  tone,  and  exhibits  more  submission  to  the 
Federal  authority  than  would  now  be  shown  by 
most  Governors.  His  clear,  far-seeing  judg- 
ment predicted  the  downfall  of  slavery,  and 
that  a  civil  war  would  be  inevitable  to  accom- 
plish that  end. 

Shortly  after  the  close  of  the  Revolutionary 
war  he  removed  to  Kentucky  from  Virginia, 
and  preempted  large  tracts  of  land  in  the  rich- 
est and  most  fertile  portions  of  the  State.  He 
erected  a  substantial  residence  built  entirely  of 
gray  granite.     He  soon  had  the  forest  cleared 


64  RE- 1  URN  FR  OM  EDINB  UR  GH. 

of  its  heavy  undergrowth,  and  to  make  the  sur- 
roundings of  his  home  more  attractive  he  spared 
from  the  axe  an  avenue  of  stately  forest  trees 
to  guide  the  visitor  to  "Traveller's  Rest," — 
an  original  name  given  by  him  to  his  homestead, 
a  name  suggestive  of  comfort  and  of  rest  to 
the  weary  pioneer,  for  at  "Travellers'  Rest" 
such  were  sure  to  find  a  welcome  and  a  haven 
from  the  perils  and  dangers  incident  to  the  life 
of  a  frontiersman.  The  present  generation 
can  never  fully  realize  the  privations  which  our 
forefathers  endured  in  order  to  civilize  this  glor- 
ious land — a  country,  as  it  has  now  become,  that 
compares  favorably  with  any  other  in  surgery, 
science,  and  literature. 

It  was  at  this  historic  homestead  that  the 
wise  men  of  the  land  met  and  held  counsel  to 
devise  means  for  the  rapid  civilizing  of  the 
country  which  was  to  be  their  future  home. 

In  recently  viewing  the  broad  fields  of  golden 
grain,  the  new-cut  grass,  the  orchards  of  ripen- 
ing fruit,  they  all  were  suggestive  of  the  pros- 
perity and  cultivation  of  one  of  Kentucky's 
most  famous  farms — "Travellers'  Rest,"  which 
is  still  in  the  possession  of  the  Shelby  family. 
The  old  rock  house  has  stood  the  storms  of 
more  than    a    century,   but    the    fierceness   of 


RE  TURN  FR  OM  EDINB  UR  GH.  ft  c 

Nature's  devastating  touch  is  not  without  its 
signs  upon  the  vine-clad  walls. 

It  was  at  this  home  that  Dr.  Ephraim  Mc- 
Dowell met,  won,  and  wedded  his  wife,  and  it 
is  in  the  family  burying  ground  belonging  to 
"Travellers'  Rest"  that  both  were  interred. 

Several  years  previous  to  his  death  Dr. 
McDowell  purchased  a  highly  improved  tract 
of  land,  with  a  modern-built,  commodious 
dwelling  upon  it,  situated  about  three  miles 
from  Danville.  Here  he  removed  with  his 
family  with  a  view  to  spending  the  remainder  of 
his  life  in  quiet,  yet  with  no  intention  of  giving 
up  his  lucrative  practice,  which  had  grown  to  be 
very  extensive.  The  yearning  of  his  heart, 
however,  was  for  a  quiet  rural  home,  where 
he  and  his  family  and  friends  might  enjoy  the 
comforts  to  be  found  in  country  living. 

When  the  footprints  of  civilization  were  un- 
known in  Kentucky,  and  only  savage  war 
whoops  resounded  through  the  depths  of  the 
forest,  there  lived  a  brave  Indian  chief  called 
"Cambiskenneth."  Dr.  McDowell  was  so  much 
pleased  with  some  of  the  noble  traits  of  char- 
acter possessed  by  this  person  that  in  honor  of 
him  he  called  his  country  seat  "Cambisken- 
neth." A  legend  runs  thus:  Cambiskenneth 
5 


66  RE  TURN  FR  OM  EDINB  UR  GH. 

was  the  chief  of  a  tribe  of  savages  that  had 
committed  many  outrages  on  the  early  set- 
tlers. In  their  perambulations  they  captured 
a  fair  young  maiden  who  had  ventured  too  far 
from  home,  and  bore  her  away  to  their  village 
(a  circumstance  not  at  all  unusual  in  those 
days).  When  they  arrived  at  their  destination, 
a  violent  controversy  arose  between  the  war- 
riors as  to  who  was  entitled  to  have  the  maiden 
for  his  wife.  In  the  midst  of  their  discussion 
the  commanding  form  of  Cambiskenneth  ap- 
peared on  the  scene.  He  silenced  them,  by 
saying  they  had  stolen  the  girl  away  without 
his  approbation  or  knowledge,  and  against  his 
avowed  principles,  and  commanded  them  to 
take  her  immediately  home.  Well  they  knew 
that  when  their  chieftain  gave  an  order  it  was 
to  be  obeyed.  For  this  act  of  mercy  the  In- 
dian was  ever  afterward  treated  with  the  great- 
est kindness  and  consideration  by  the  settlers. 
Travellers  in  passing  over  "Muldrow's  Hill" 
pause  to  look  at  a  mound  of  considerable  height 
bordered  by  a  crude  granite  slab  that  marks  the 
last  resting-place  of  the  brave  and  noble  Cam- 
biskenneth. 

Although  Dr.  McDowell  was  a  slave-owner, 
he   recognized  the  negro   as  belonging  to  the 


RETURN  FROM  EDINBURGH. 


67 


human  race.  His  own  slaves  were  treated 
with  the  utmost  kindness  and  considera- 
tion by  himself,  and  as  well  by  his  entire 
family.  He  was  never  known  to  traffic  in 
slaves,  but  would  frequently  purchase  a  man 
or  a  woman  if  one  had  fancied  and  married  a 
servant  belonging  to  himself.  He  would  never 
under  any  consideration  separate  families.  He 
evidently  had  a  more  tender  feeling  for  the 
negro  than  had  the  renowned  Dr.  Johnson, 
who  is  reported  as  saying  that  a  negress  could 
"bear  cutting  about  as  well  as  could  a  dog  or  a 
rabbit." 

Dr.  McDowell  was  a  prayerful  man,  as,  an 
evidence  of  which  we  have  the  following  invoca- 
tion offered  up  by  him  to  the  Divine  Master  a 
few  hours  before  the  appointed  time  to  make  the 
first  "  ovariotomy."  He  realized  that  his  feeble 
hand,  without  the  strengthening  power  of  the 
Almighty  Father,  would  prove  futile  in  the  try- 
ing experiment  he  was  about  to  make.  It  was 
an  event  that  was  to  render  his  name  immortal, 
and  be  the  means  of  saving  countless  numbers 
of  lives  ;  otherwise,  in  case  of  failure  of  the 
operation,  was  to  prove  his  destruction. 

It  was  truly  a  trying  hour  with  him,  and  it 
was  well  that  he  sought  his  closet  and  in  ear- 


68  ££  TURN  FR OM  EDINB  UR GH. 

nest  prayer  made  an  appeal  to  God  to  be  with 
and  help  him.  His  abiding  faith  in  the  efficacy 
of  prayer  was  beautiful,  and  no  doubt  his  re- 
markable success  in  the  field  of  surgery  can 
be  largely  attributed  to  his  strong  convictions 
and  unwavering  faith  in  the  Great  Jehovah. 

Remembering  the  prayer  and  writing  it  down 
with  his  own  fingers  he  placed  it  in  his  pocket, 
thinking  some  day  that  his  faithful  wife  might 
accidentally  find  it — perhaps  after  his  death,  for 
threatening  clouds  were  gathering  about  him 
as  the  time  drew  near  for  him  to  perform  the 
operation  upon  Mrs.  Crawford. 

THE    PRAYER. 

"Almighty  God  be  with  me  I  humbly  be- 
seech Thee,  in  this  attendance  in  Thy  holy 
hour  ;  give  me  becoming  awe  of  Thy  presence, 
grant  me  Thy  direction  and  aid,  I  beseech 
Thee,  that  in  confessing  I  may  be  humble  and 
truly  penitent  in  prayer,  serious  and  devout  in 
praises,  grateful  and  sincere,  and  in  hearing 
Thy  word  attentive,  and  willing  and  desirous 
to  be  instructed.  Direct  me,  oh!  God,  in  per- 
forming this  operation,  for  I  am  but  an  instru- 
ment in  Thy  hands,  and  am  but  Thy  servant, 
and  if  it  is  Thy  will,  oh !  spare  this  poor  afflicted 


RE  TURN  FR  OM  EDINB  UR  GH.  fig 

woman.  Oh!  give  me  true  faith  in  the  atone- 
ment of  Thy  Son,  Jesus  Christ,  or  a  love  suffi- 
cient to  procure  Thy  favor  and  blessing;  that 
worshipping  Thee  in  spirit  and  in  truth  my 
services  may  be  accepted  through  his  all-suffi- 
cient merit.     Amen." 


CHAPTER   V. 

THE    FIRST    CASE    OF    OVARIOTOMY. 

It  was  on  the  thirteenth  day  of  December, 
1809,  when  Dr,  McDowell  had  been  practis- 
ing his  profession  fourteen  years,  that  he  was 
sent  for  to  see  Mrs.  Crawford,  residing  in 
Green  County,  Kentucky,  some  sixty  miles  from 
Danville,  who  was  thought  by  her  physicians 
to  have  gone  long  beyond  her  time  in  preg- 
nancy, and  to  be  the  subject  of  extra-uterine 
fcetation.  McDowell  found  her  trouble  to  be 
an  ovarian  tumor,  rapidly  hastening  to  a  fatal 
termination.  To  quote  the  graphic  description 
of  Dr.  Gross:  "After  a  most  thorough  and 
critical  examination,  Dr.  McDowell  informed 
his  patient,  a  woman  of  unusual  courage  and 
strength  of  mind,  that  the  only  chance  for 
relief  was  the  removal  of  the  diseased  mass. 
He  explained  to  her  with  great  clearness  and 
fidelity,  the  nature  and  hazard  of  the  operation. 
He  told  her  that  he  had  never  performed  it, 
but  that  he  was  ready,  if  she  were  willing,  to 
(70) 


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FIRST  CASE  OF  OVARIOTOMY.  yl 

undertake  it,  and  to  risk  his  reputation  on  the 
issue,  adding  that  it  was  an  experiment,  but 
one  well  worthy  of  trial." 

Mrs.  Crawford  listened  to  the  surgeon  with 
great  patience  and  coolness,  and  at  the  close 
of  the  interview  promptly  assured  him  that  she 
was  not  only  willing,  but  ready  to  submit  to  his 
decision,  asserting  that  any  performance  which 
held  out  even  the  most  remote  prospect  of  relief 
was  preferable  to  the  ceaseless  agony  she  suf- 
fered. 

The  result  has  long  been  before  the  profes- 
sion. 

McDowell  was  conscious  at  the  time  he 
was  doing  the  operation,  that  an  angry  and 
excited  crowd  of  men  were  collected  in  the 
street  awaiting  the  result  of  his  experiment 
of  "butchering  a  woman,"  as  they  expressed  . 
it.  Had  she  died  under  the  operation,  there 
was  no  law  in  those  primitive  days  sufficiently 
strong  to  have  protected  him  from  the  people 
who  were  clamoring-  for  his  life — determined 
men  who  would  have  shown  no  mercy,  for  they 
regarded  it  a  duty  to  avenge  the  wrong  inflicted 
on  Mrs.  Crawford.  Indeed  his  life  hung  on  the 
recovery  of  the  heroic  woman.  What  nerve,  what 
confidence  in  God  and  in  his  own  ability,  must 


j2  FIRST  CASE  OF  OVARIOTOMY. 

the  surgeon  have  possessed  to  venture  the  per- 
formance of  an  operation  of  the  magnitude  of 
ovariotomy  under  such  circumstances.  No 
soothing  balm  to  quiet  the  nerves  of  his 
patient;  only  a  covering  thrown  over  her  pallid 
face  to  shut  out  from  her  view  the  flashing  of 
the  few  instruments  that  he  used. 

This  signal  event  in  the  life  of  the  illustrious 
surgeon  cannot  fail  to  impress  a  reader  with 
the  remarkable  firmness  of  nerve  and,  as 
well,  the  surgical  genius  possessed  by  Dr.  Mc- 
Dowell. It  portrays  strength  in  his  character 
worthy  of  much  more  than  a  passing  notice, 
and  proves  conclusively  that  the  operative 
germ  slumbered  in  his  mind,  waiting  a  proper 
subject.  This  subject  came  in  the  person  of 
Mrs.  Crawford. 

Dr.  McDowell's  close  observation  of  manip- 
ulations practised  on  certain  of  the  lower  ani- 
mals, together  with  lasting  impressions  received 
from  his  old  preceptor,  generated,  no  doubt, 
the  thought  of  his  operation  of  ovariotomy, 
while  consciousness  of  skill,  and  of  dexterity  in 
handling  the  scalpel,  gave  him  confidence  and 
courage  in  his  own  ability.  With  these  was 
combined  a  firm  conviction  in  the  efficacy  of 
prayer. 


FIRST  CASE  OF  OVARIOTOMY.  73 

As  one  of  Chicago's  most  prominent  sur- 
geons remarked  in  speaking  of  the  operation, 
"Your  grandfather  was  the  instrument  and  God 
the  great  surgeon  that  did  the  work."  It  really 
seems  that  there  is  much  truth  in  these  words, 
and,  remembering:  all  the  attending  circum- 
stances  under  which  it  was  performed,  that 
McDowell  was  inspired  to  do  the  operation — 
one  hitherto  unknown  to  the  world. 

We  regret  our  inability  to  furnish  a  life 
picture  of  Mrs.  Crawford,  owing  to  her  never 
having  had  one  taken.  This  heroic  woman, 
whose  courage  gave  Dr.  McDowell  an  oppor- 
tunity to  win  immortal  fame,  survived  the 
operation  thirty-two  years  in  good  health.  She 
was  of  a  highly  respectable  Kentucky  family 
and  bore  a  son,  who,  at  one  time,  was  Mayor 
of  Louisville,  Kentucky.  She  was  above  the 
medium  height  and  weighed,  before  her  afflic- 
tion, one  hundred  and  sixty-five  pounds.  Her 
form  was  good,  and  her  face  represented  char- 
acter and  determination  of  spirit.  Her  eyes 
were  of  that  full,  gray  kind  which  indicate 
firmness.  Her  forehead  was  overhung  with 
clusters  of  wavy  brown  hair.  She  was  not 
a  handsome  woman,  her  features  being  too 
prominent     and     large,     and     her     lips     too 


74  FIRST  CASE  OF  OVARIOTOMY. 

firmly  set  and  curling.  For  some  years  after 
the  operation  was  performed  upon  her,  she  re- 
mained at  her  old  home  in  Green  County, 
Kentucky,  but  finally  moved  with  her  family  to 
Indiana,  where  she  lived  until  her  death. 

So  far  as  we  have  been  able  to  ascertain, 
the  degree  of  MCD.  was  not  possessed  by  him 
until  the  year  1825,  when,  entirely  unsolicited 
on  his  part,  the  University  of  Maryland  honored 
itself  by  conferring  upon  him  its  honorary 
diploma.  The  Medical  Society  of  Philadel- 
phia, at  that  time  the  oldest  and  most  distin- 
guished of  the  kind  in  this  country,  had  sent 
him  its  acknowledgment  in  the  year  181 7.  The 
following  names  are  identical  with  those  at- 
tached to  the  diploma  presented  him  in  1825, 
by  the  University  of  Maryland : 

John  P.  Davidge,  A.M.,  M.D., 

Professor  of  Anatomy. 

Nathaniel  Potter,  M.D., 

Prufessor  of  Theory  and  Practice  of  Medicine, 

Elisha  DeButts,  M.D., 

Professor  of  Chemistry. 

Samuel  Baker,  M.D., 

Professor  of  Materia  Medica. 

Richard  Wilmot  Hall,  M.D., 

Professor  of  Obstetrics. 

Maxwell  McDowell,  M.D., 

Professor  of  Institutes  of  Medicine. 

Granville  Sharp  Pattison, 

Professor  of  Surgery. 

James  Kemp,  D.D., 

Prsfectus. 

Johannes  Allen, 

Professor  of  Mathematics. 


FIRST  CASE   OF  OVARIOTOMY.  75 

Copy  of  the  diploma  awarded  to  Ephraim 
McDowell,  by  the  University  of  Maryland,  in 
the  year  1825  : 

Academia  Terrse  Marise  Omnibus  ad  quos  has  literae  per- 
venerint  Salutem.  Cum  mos  sit  antiquus  et  laudabilis  ut  qui 
multolabore  studioque  assiduo  literis  operam  navaverint  ii 
insigni  aliquo  honoris  titulo  condecorentur  cumque  nobis 
compertum  sit  Dominum  E.  M.  rerum  Medicinalium  et  Phil- 
osophicarum  scientia  et  usuperitissimum  et  omnino  talem 
esse  quern  summi  in  Medicina  honores  deceant  potius  ultro 
ambiant ;  Nos  eundem  doctissimum  virum  E.  M.  summo  quo 
potuimus  honore  prosequi  volentes  Medicinae  Doctorem  rite 
et  legitime  creavimus,  renuntiavimus,  eique  tanquam  vere 
idoneo  et  optime  merito  omnia  Jura,  Honores  et  Privilegia 
contulimus  quae  Medicinae  Doctori  legibus  aut  consuetudine 
conceditribuique  solent.  In  quorum  fidem  literis  hisce  sigillo 
Academiae  communi  munitis  nomina  nostra  subscripsimus. 
Datum  Urbe  Baltimoriensi  Mensis.  Aprilis  die  quarto  Anno 
Domini  MDCCCXXV. 

Jas.  Kemp,  D.D.,  Praefectus. 

Joannes  B.  Davidge,  A.M.,  M.D.,  Art.  Incid.  Prof. 

Nath'l  Potter,  M.D..  Theoret.  Med.  et  Prax.  Prof. 

Eliska  DeButts,  M.D.,  Chem.  Prof. 

Samuel  Baker,  M.D.,  Mat.  Med.  Prof. 

Rich'd  Wilmot  Hall,  M.D.,  Obstetri.  Prof. 

Maxwell  McDowell,  M.D.,  Inst.  Med.  Prof. 

Granville  Sharp  Pattison,  Chir.  Prof. 

Dr.  McDowell  certainly  stood  in  his  own 
light  out  of  failure  to  report  the  numerous  and 
skilful  operations  he  performed,  but  at  the 
same  time  many  excuses  are  to  be  made  for 


7g  FIRST  CASE  OF  OVARIOTOMY. 

him.  The  condition  of  the  country,  the  times 
in  which  he  lived,  and  his  great  aversion  to 
writing,  palliate  the  seeming  neglect  of  what 
appears  to  have  been  his  duty.  He  was  so 
negligent  as  to  corresponding  that  when  absent 
from  home  he  would  seldom  send  a  letter 
to  his  immediate  family,  unless  emergency 
demanded  it.  From  the  fact  of  his  not  re- 
porting his  minor  operations  they  are  lost 
to  his  credit.  A  prominent  Brooklyn  surgeon 
said  that  he  knew  from  good  authority  that 
Dr.  McDowell  was  the  first  to  perform  the 
Caesarean  section  in  this  country  successfully, 
the  operation  being  done  in  New  York  City. 
No  report  of  the  case  was  made. 

He  was  remarkably  successful  in  general 
surgical  work,  and  we  have  ascertained  from 
authentic  sources  that  he  was  the  first  to 
venture  upon  a  partial  excision  of  the  inferior 
maxillary  bone.  Afterward  Dr.  Wood,  of  New 
York,  perfected  the  operation  and  obtained  the 
honor.  Dr.  McDowell  was  really  the  origina- 
tor of  the  performance,  though,  as  usual,  he 
made  no  public  account  of  it. 

One  of  his  (Dr.  McDowell)  most  interesting 
cases,  in  consequence  of  the  exalted  position 
afterward  attained  by  the  patient,  was  that  of 


FIRST  CASE  OF  OVARIOTOMY.  yj 

James  K.  Polk,  President  of  the  United  States. 
This  gentleman  had  suffered  for  years  from 
symptoms  of  vesical  calculus,  and  in  1812, 
when  in  his  seventeenth  year,  he  was  induced 
to  consult  Dr.  McDowell,  at  Danville.  He 
carried  the  stone  home  with  him,  not  in  his 
bladder,  but  in  his  pocket,  to  show  to  his 
friends  and  neighbors.  In  a  letter  dated  Maury 
County,  West  Tennessee,  December  3d  (which 
letter  we  have  been  unable  to  procure),  he  in- 
formed Dr.  McDowell  of  the  progress  of  his 
cure,  and  feelingly  expressed  his  gratitude  for 
the  services  which  he  had  received  from  him. 
The  bad  orthography  and  worse  grammar  con- 
tained in  this  letter,  could  but  be  contrasted 
with  the  contents  of  one  which  he  wrote  to 
Dr.  McDowell  fourteen  years  afterward,  when 
he  represented  Tennessee  in  the  Congress  of 
the  United  States.  This  second  was  written 
with  accuracy  and  even  eloquence. 

Mr.  Polk  says : 

"My  Dear  Dr.:  I  have  been  enabled  to  ob- 
tain an  education,  study  the  profession  of  law, 
and  embark  successfully  in  the  practice  ;  have 
married  a  wife  and  permanently  settled  in 
Tennessee,  and  now  occupy  the  station  in 
which  the  good  wishes  of  fellow  citizens  have 


7g  FIRST  CASE  OF  OVARIOTOMY. 

placed  me.  When  I  reflect,  the  contrast  is 
imposing  indeed,  between  the  boy,  the  meagre 
boy,  with  pallid  cheeks,  oppressed  and  worn 
down  with  disease,  when  he  first  presented 
himself  to  your  kind  notice  in  Danville,  nearly 
fourteen  years  ago,  and  the  man  of  to-day  in 
the  full  enjoyment  of  perfect  health." 

And  this  greatest  boon,  "perfect  health," 
which  he  was  enjoying,  he  owed  to  Dr.  Mc- 
Dowell. President  Polk  early  in  life  was  per- 
manently cured  of  a  hernia  by  him. 

It  is  evident  that  Dr.  McDowell  was  an  ex- 
ceedingly cautious  practitioner,  always  looking 
to  the  preparation  of  the  patient's  system 
before  going  into  an  operation.  His  anatomi- 
cal knowledge,  dexterity,  and  his  courage  were 
sufficient  to  enable  him  to  execute  any  manipu- 
lation that  might  have  been  required  within  the 
circle  of  his  extensive  practice.  He  took  espe- 
cial pains  in  aiding  his  pupils  to  acquire  a 
knowledge  of  the  human  structure. 

Upon  three  occasions,  while  in  Europe,  he 
did  the  Csesarean  section,  and  with  the  first 
two  cases  both  mother  and  child  lived.  He 
never  reported  these  operations,  and  the  mem- 
bers of  his  family  were  the  only  persons  that 
preserved  a  record  of  the  fact. 


FIRST  CASE  OF  OVARIOTOMY.  jg 

He  seemed  in  his  surgical  ambition,  as  he 
increased  in  years  and  confidence,  to  become 
lost  in  all-absorbing  thought  as  to  how  to  help 
suffering  humanity. 

Some  writer  has  wisely  remarked,  in  vindica- 
tion of  surgeons  and  men  of  the  healing  art 
who  have  borne  the  semblance  of  having  been 
remiss  in  their  reports  of  important  cases  or 
discoveries,  that  "in  former  times  before  the 
organization  of  the  numerous  medical  vehicles 
and  medical  colleges  and  societies  which  now 
exist  throughout  the  civilized  land,  and  when  a 
medical  journal  was  almost  unknown,  there  was 
an  excuse  for  failure  to  bring  one's  original 
work  and  discoveries  promptly  before  the  medi- 
cal profession,  as  was  the  case  with  Ephraim  Mc- 
Dowell, but  now  the  facilities  for  communicat- 
ing being  so  general  no  excuse  is  to  be  made 
for  the  delinquent  pioneer,  for  such  are  not  with- 
out opportunities  to  inform  the  profession  as 
to  what  they  have  done  or  are  doing.  Indeed 
they  are  even  urged  and  importuned  to  do  so 
by  the  enterprise  of  medical  journalists,  and 
the  officers  of  medical  societies.  One  who  in 
this  day  locks  up  in  his  own  bosom,  and  for 
years,  the  knowledge  of  a  valuable  discovery 
may  well  be  asked  if  he  has  not  forfeited  all 


So  FIRST  CASE  OF  OVARIOTOMY. 

claims  under  a  statute  of  limitation,  by  reason 
of  his  neglect  or  of  a  desire  to  conceal." 

The  reader  must  bear  in  mind  that  at  the 
time  McDowell  lived  and  practised  his  pro- 
fession, there  were  even  no  stage  coaches  in 
use  ;  the  only  mode  of  transportation  being  by 
horseback,  and  journeys  were  often  attended 
with  great  danger  and  much  privation  to  the 
traveller.  Fifty  or  one  hundred  miles  was  con- 
sidered no  uncommon  distance  for  a  physician 
to  be  called  to  see  a  patient.  Dr.  McDowell 
was  frequently  so  sent  for,  and  it  became 
necessary  for  him  to  take  such  long  journeys, 
carrying  his  medicines  and  surgical  instruments 
in  "saddlebags,"  a  manner  of  practice  unknown 
to  physicians  of  the  present  day.  His  earthly 
mission  was,  indeed,  to  relieve  the  sufferings  of 
his  fellow  beinp-s. 

On  one  occasion  he  was  called  to  see  a 
patient  who  lived  over  a  hundred  miles  distant 
from  his  home.  It  was  an  important  surgical 
operation  that  was  required  and  which  de- 
manded speedy  attention,  and  although  it  was 
in  a  season  of  the  year  when  the  streams  and 
brooks  throughout  the  entire  country  were 
swollen  beyond  their  utmost  capacity,  when 
little  rivulets  had  become  rushing  creeks,  and 


FIRST  CASE  OF  OVARIOTOMY.  8 1 

small  brooks  wide-spreading  rivers,  causing 
peril  and  danger  to  the  traveller,  he  ven- 
tured upon  his  journey.  His  devoted  wife 
entreated  him  not  to  go — not  to  risk  his  life. 
But  duty  called  him,  and  that  summons  must 
be  obeyed.  She  hastily  prepared  the  necessary 
articles  for  the  trip,  and  with  many  misgiv- 
ings bade  him  farewell.  He  mounted  his  faith- 
ful horse  that  had  borne  him  in  safety  on 
many  a  similar  errand,  and  soon  was  lost  to 
sight  in  the  distance.  After  having  ridden 
some  forty  miles  he  came  to  a  stream  of  water 
overflowing  its  banks.  For  a  moment  he 
viewed  the  swollen  current,  meditating  on  what 
course  to  pursue,  for  the  driftwood  was  dash- 
ing and  driving  with  such  force  that  he  feared 
(should  he  attempt  to  cross)  collision  with  it. 
There  was  no  alternative,  however,  but  to  let 
his  horse  have  the  rein  and  swim  the  angry 
torrent,  that  seemed  bidding  defiance  to  the 
doctor  and  to  his  mission  of  mercy. 

He  realized  his  danger  in  attempting  to 
cross,  but  the  beautiful  Christian  faith  mani- 
fested itself  to  him,  and  a  still,  small  voice 
whispered  "Fear  nothing,  for  I  am  with  thee," 
and  the  next  moment  he  threw  the  bridle 
over     his     horse's     head,     and    with    charac- 

6 


82  FIRST  CASE  OF  OVARIOTOMY.    ■ 

teristic  instinct  the  animal  plunged  into  the 
surging  water.  At  times  the  doctor  stood  in 
his  stirrups  trying  to  escape  the  debris  that 
threatened  destruction  to  both  horse  and  rider. 
Finally  a  heavy  saw-log  came  in  contact  with 
the  horse,  almost  causing  the  struggling  animal 
to  drown,  but  with  herculean  strength  he  over- 
came the  dangerous  situation,  and  raising  his 
head  in  the  air  and  blowing  the  muddy  water 
from  his  distended  nostrils,  swam  with  a  des- 
perate effort  safely  to  shore.  The  doctor 
arrived  at  his  destination,  performed  the  critical 
work  successfully,  and  returned  to  his  home 
thankful  and  happy.  Our  forefathers  who 
selected  the  profession  of  medicine,  certainly 
practised  it  under  great  difficulties. 

Is  the  restless  spirit  of  man  in  this  progres- 
sive age  as  content  and  happy,  surrounded 
with  all  the  modern  luxuries,  as  were  our  fore- 
fathers in  their  primitive  homes,  free  from 
ambitious  pride  and  desire  to  excel  their 
neighbors  ?  We  think  that  we  can  answer  this 
question  through  the  peaceful  family  circle  of 
Dr.  McDowell.  He  could  say  as  did  the  Apos- 
tle Paul :  "I  have  learned  in  whatsoever  state  I 
am,  therewith  to  be  content,"  and  therein  lies 
the  true  state  of  happiness.     This  is  to  a  great 


FIRST  CASE  OF  OVARIOTOMY.  33 

degree  the  secret  of  Dr.  McDowell's  mighty 
faith,  and  it  is  a  secret  all  would  do  well  to 
learn. 

His  hospitality  was  proverbially  known,  and 
it  was  seldom  that  "Cambiskenneth"  was  with- 
out visitors.  Mrs.  McDowell  being  a  model 
housewife,  order  and  method  prevailed.  Her 
domestic  discipline  was  perfect,  and  had, 
blended  with  it,  kindness  and  consideration. 
It  was  a  pleasure  to  be  a  guest  in  such  a 
well-regulated  household. 

Dr.  McDowell's  great  benevolence  was  one 
of  the  marked  characteristics  of  his  nature,  and 
much  of  his  daily  practice  was  gratis.  The 
writer  had  the  pleasure  of  meeting  several  very 
aged  persons  who  remembered  vividly  the  many 
cases  which  he  had  operated  upon,  without  in 
a  single  instance  making  any  charge.  A  poor 
woman  from  the  mountains  of  Tennessee  hear- 
ing of  the  doctor's  wonderful  skill,  and  feeling 
convinced  that  some  dreadful  affliction  had  be- 
fallen her,  wrote  him  soliciting  advice  as  to 
what  to  do.  He  replied,  asking  after  symp- 
toms and  everything  connected  with  her  case. 
She  sent  the  required  word,  and  he  was  con- 
vinced that  she  had  an  ovarian  tumor ;  not  being 
satisfied  with  a  seeming  neglect  to  give  her  the 


84  FIRST  CASE  OF  OVARIOTOMY. 

required  professional  assistance,  he  made  a 
journey  to  see  her.  Her  condition  was  found 
deplorable,  as  she  was  suffering  from  the 
disease  inferred.  He  operated  successfully 
upon  her,  making  no  charge;  his  remuneration 
were  these  words  :  "God  will  bless  you,  doctor, 
for  having  saved  my  life." 


CHAPTER  VI. 


PERSECUTIONS. 


As  Dr.  McDowell  ascended  the  ladder  of 
fame  persecutions  went  with  him  ;  men  in  the 
profession,  be  it  told  to  their  dishonor,  resorted 
to  unprofessional  acts  to  traduce  and  injure  the 
high  standing  and  irreproachable  character  of 
the  dauntless  surgeon.  Providence  had,  how- 
ever, spared  the  life  of  brave  Mrs.  Crawford, 
and  by  so  doing  ovariotomy  was  founded. 

It  is  a  noted  fact,  and  undisputed  experience 
shows  it,  that  the  man  of  genius,  the  man 
destined  to  rise,  must  traverse  the  rank  and 
foulsome  sloughs  of  envious  persecution,  until 
victory  carries  him  out  of  them.  Wisely  said 
Professor  Tyndale  recently  in  speaking  of  the 
discouragements  men  of  genius  had  to  contend 
against:  "A  great  theory  has  never  been  ac- 
cepted without  opposition.  Such  must  always 
be  the  course  of  things  so  long  as  men  are 
endowed  with  different  degrees  of  insight : 
where  the  mind  of  genius  discerns  the  distant 

(S5) 


86  PERSECUTIONS. 

truth  which  it  pursues,  the  mind  not  so  gifted 
often  sees  nothing  but  the  extravagance  which 
it  avoids." 

As  an  instance  of  a  spirit  of  jealousy  on  the 
part  of  a  member  of  the  medical  profession  the 
following  is  to  be  noted.  During  one  of  the 
occasional  absences  from  home  of  Dr.  Mc- 
Dowell, his  wife  had  a  slight  indisposition.  Dr. 
Hunn,  a  self-important,  opinionated  and  aristo- 
cratic old  man,  living  in  Danville  and  not  far 
from  the  residence  of  McDowell,  was  called  in 
to  see  her.  He  diagnosed  the  case,  and  with 
characteristic  malevolence,  to  be  appreciated  in 
the  reading  of  a  succeeding  paragraph,  at  once 
declared  her  to  be  dangerously  poisoned,  but 
said  that  if  the  family  would  have  a  cow  driven 
into  the  yard,  so  that  he  might  have  fresh  milk 
whenever  called  for,  he  could  save  her.  All  was 
arranged  as  he  directed,  and  in  due  course  of 
time  Mrs.  McDowell  recovered.  Nature  was 
the  successful  physician. 

It  seems  to  be  a  false  dignity,  a  mistaken 
notion  of  elevated  character,  that  prompts  the 
worthy  and  skilful  physician  to  stand  idly  by 
and  see  the  substantial  rewards  of  his  labor 
appropriated  by  shameless  pretenders.  There 
is  such  a  sympathy  between  this  class  of  indi- 


PERSECUTIONS.  gy 

viduals  and  the  people  generally,  that  it  would 
be  but  a  just  retribution  should  scientific  physi- 
cians abandon  the  field,  and  leave  the  public 
entirely  in  the  hands  of  the  nostrum-venders 
and  advertising  charlatans, — at  least  for  a  gen- 
eration or  two,  or  until  men  shall  have  learned 
to  appreciate  the  true  physician  and  his  scien- 
tific acquirements, 

The  Dr.  Hunn  alluded  to  above,  in  order  to 
injure  the  social  standing  of  McDowell,  fabri- 
cated a  wicked  falsehood,  reporting  that  Mrs. 
McDowell  had  been  poisoned  by  a  young 
medical  student  at  that  time  in  the  office  of 
her  husband,  and  that  this  pale,  interesting 
man  of  medicine  was  none  other  than  a  young 
lady  dressed  in  mans  clothing.  The  assertion, 
malevolent  lie  as  it  was,  found  acceptance  by 
some  of  the  credulous,  and  not  until  after  the 
marriage  of  the  student,  and  he  or  she  becom- 
ing a  father,  were  their  minds  disabused  of 
this  wicked  impression.  We  relate  the  incident 
as  showing  one  of  the  many  annoyances  to 
which  Dr.  McDowell  was  subjected.  It  was 
only,  however,  when  enemies  assailed  his  pri- 
vate character  that  his  indignation  was  aroused. 
He  was  a  brave  man,  but  one  of  such  decision 
of  character  as  to  be  master  of   his  passions 


88  PERSECUTIONS. 

and  will.  He  usually  armed  himself  when 
called  at  night  to  visit  a  patient,  especially  in 
the  country.  He  only  feared  the  assassin, 
who  "loves  darkness  rather  than  light." 

His  persecutions  were  very  annoying,  and 
his  own  profession  denounced  him  as  a  cruel, 
wicked  person,  who  had  no  sympathy  for  man 
or  woman — that  he  gloried  in  cutting  open  the 
belly  of  a  woman.  His  most  intimate  profes- 
sional friends  avoided  him,  and  the  prejudice 
was  carried  so  far  that  he  was  socially  shunned 
by  many.  The  negroes  of  the  village  and  the 
surrounding  country  being  naturally  ignorant 
and  superstitious,  whenever  they  spied  Dr. 
McDowell  walking  in  the  distance,  would  rush 
into  the  nearest  building,  fearing  that  he  might 
waylay  and  maltreat  them.  They  feared  him 
as  they  would  some  beast  of  prey.  Indeed 
they  could  scarcely  be  induced  to  venture  out 
after  twilight,  unless  McDowell  was  absent 
from  home.  For  this  fear,  their  masters  were, 
of  course,  responsible. 

But  he  had  his  sport  out  of  them.  One  after- 
noon as  he  was  wending  his  way  homeward,  he 
met,  in  a  solitary  part  of  the  road,  a  burly  negro 
face  to  face.  The  man  looked  an  instant  at 
the  doctor,  and  then  attempted  to  run,  but  being 


PERSECUTIONS.  gg 

ordered,  halted.  With  wild,  staring  eyes,  and 
terrified  face,  the  negro  gave  one  unearthly 
groan  and  falling  upon  his  knees  offered  up  an 
appeal  to  God  that  would  have  touched  a  heart 
of  stone.  When  he  stopped  praying,  the  doc- 
tor talked  with  him,  trying  to  make  the  man 
understand  his  foolishness.  The  negro  stated 
that  he  had  heard  his  old  master  say,  "That 
Dr.  McDowell  was  next  to  the  devil — that  he 
went  about  cutting  people  open  and  killing 
them."  To  the  time  of  his  death,  the  ignorant 
residents,  both  white  and  black,  held  such  ideas 
of  him,  and  no  argument  could  disabuse  their 
minds  of  the  uncanny  impressions. 

Though  his  trials  were  many,  they  were  dis- 
pelled by  his  abiding  faith  and  by  happy  influ- 
ences related  with  his  family  circle.  He  taught 
his  children,  when  engaged  in  sport,  to  regard 
him  as  one  of  themselves,  dispossessing  himself 
of  that  forbidding  awe  with  which  parents  too 
frequently  wean  off  their  offspring. 

It  is  a  remarkable  fact  that  a  man  so  true 
and  sincere  in  his  nature,  as  was  Dr.  McDowell, 
should  have  been  a  target  for  an  envious  pre- 
tender to  hurl  his  venomous  darts  against. 

In  reading  the  medical  literature  of  the  present 


go  PERSECUTIONS. 

age,  we  were  chagrined  at  the  unfairness  meted 
out  to  Dr.  McDowell  by  Mr.  Lizars,  who  should 
have  risen  above  such  (to  say  the  least  of  it) 
an  unprofessional  as  well  as  dishonorable  act, 
if  the  act  were  not  due  to  negligence.  True, 
Mr.  Lizars  is  now  numbered  with  the  dead,  and 
the  thought  may  occur,  let  the  faults  of  the 
dead  be  buried  with  them.  Very  well  and  just, 
but  the  deeply  wronged  McDowell  likewise 
sleeps  with  the  dead,  and  the  injustice  done 
him  cries  to  be  righted,  and  it  is  our  privilege 
and  duty  to  gather  all  the  facts  relating  to  him 
and  his  works.  Our  object  is  to  place  the  illus- 
trious surgeon  where  he  should  be,  and  to  state 
truths  regarding  him. 

Professor  William  Tod  HelmUth,  a  renowned 
surgeon,  says  that  the  national  pride  of  every 
American  physician  is  to  find  gratification  "in 
pronouncing  Ephraim  McDowell  'The  father  of 
ovariotomy,'  not  of  American  ovariotomy,  but  of 
ovariotomy  the  world  over,  and  especially  of 
ovariotomy  in  Great  Britain.  I  am  urged  to  this 
decisive  pronunciation,  because  the  endeavor  has 
constantly  been  made  in  England  to  deprive  the 
American  people  of  the  honor  which  belongs  to 
them  in  this  regard."  Then  he  says  further,  that 
in   1817,  Dr.  McDowell  prepared  a  report  of 


PERSECUTIONS.  g ! 

his  cases,  and  with  justifiable  pride  sent  a 
copy  to  his  friend  and  former  preceptor  Mr. 
Bell,  whose  health  had  failed,  and  who  was  then 
travelling-  on  the  Continent.  Mr.  Lizars  had 
charge  of  Bell's  correspondence  and  practice, 
and  failed  to  transmit  the  report  to  him.  Seven 
years  later  Mr.  Lizars  brought  them  to  light 
(Dr.  Peaslee  says  they  slumbered  for  seven 
years  for  some  cause  then  unknown),  and  when 
he  did  so,  they  appeared  as-  an  appendix  to  a 
paper  recording  a  case  of  his  own,  which  proved 
to  be  not  ovariotomy,  but  one  simply  of  an 
accumulation  oi  fat. 

Mr.  Christopher  Heath  thus  spoke  to  his  class  : 
"Although  ovariotomy  was  first  performed 
by  Dr.  Ephraim  McDowell,  of  Danville,  Ken- 
tucky, who  was  a  pupil  of  John  Bell,  the  opera- 
tion of  modern  times  has  been  entirely  of  Brit- 
ish cultivation.  Mr.  Lizars,  of  Edinburgh,  was 
the  first  to  attempt  ovariotomy  in  this  country, 
and  by  the  long  incision,  i.  e.,  from  the  umbili- 
cus to  the  pubes  ;  his  example  was  followed  by 
a  few  other  surgeons  and  from  time  to  time  a 
success  was  obtained."  Mr.  Heath  allowed 
himself  to  overlook,  ignorantly  or  wittingly, 
Dr.  McDowell's  eight  successful  cases  attend- 
ing thirteen  operations. 


PERSE  CUTIONS. 


92 

The  facts  are  that  had  Mr.  Lizars  not  read 
and  studied  Dr.  McDowell's  report  he  would 
never  have  attempted  the  operation,  and  when 
he  did  make  such  attempt  he  mistook  a  lump 
of  fat  for  an  enlarged  ovary ;  examination 
showing  both  organs  to  be  healthy.  Notwith- 
standing this  humiliating  fact,  Mr.  Lizars  again 
attempted  the  performance,  but  in  two  cases 
was  unable  to  remove  the  tumors,  and  in  the 
third  case  mistook  a  sub-peritoneal  uterine 
fibroid  for  a  cystoma  ovaria. 

The  learned  professor  of  surgery  goes 
on  to  say:  "These  facts  are  very  well 
known  to  every  gynecologist,  and  though 
still  of  interest  to  the  general  practitioner, 
would  not  have  been  mentioned  here  had 
it  not  been  that  effort  has  recently  been 
made  in  England  by  one  high  in  authority,  to 
give  priority  in  the  performance  of  ovariotomy 
to  a  certain  Robert  Houstoun,  of  Glascow.  In 
Mr.  Lawson  Tait's  latest  work,  1883,  the  en- 
deavor of  the  author  to  procure  for  Great  Bri- 
tain precedence  in  the  performance  of  this 
operation  is  so  apparent  and  indeed  so  over- 
drawn that  the  animus  is  plainly  perceptible." 

We  find  the  case  of  Mr.  Houstoun  which 
Mr.  Tait  refers  to,  in  the  Philosophical  Trans- 


PERSECUTIONS.  93 

actions:  (From  the  year  1719  to  the  year 
1 733)-  Abridged  and  Disposed  under  General 
Heads,    Vol.    vii.,    pp.    541-546.    published   in 

1834. 

We  refer  the  reader  to  Case  XXVIII.  therein 
reported,  being  that  of  Margaret  Millar  : 

"In  Aug.  1 70 1.  Margaret  Millar,  living 
not  far  from  Glascow,  informed  me,  that 
her  Midwife,  in  her  last  Lying-in,  at  45 
years  old,  having  violently  pulled  away  the 
Burthen,  she  was  so  very  sensibly  affected 
by  a  Pain,  which  then  seized  her  in  the  left 
Side,  between  the  Umbilicus  and  Groin,  that 
she  scarce  ever  had  been  free  from  it  after, 
but  that  it  had  troubled  her  more,  or  less,  dur- 
ing 1 3  Years  together  ;  that  for  two  Years  past 
she  had  been  extremely  uneasy,  her  Belly  grew 
very  large,  and  a  Difficulty  of  breathing  in- 
creased continually  upon  her  ;  insomuch,  that 
for  the  last  six  Months,  she  had  breathed  with 
the  utmost  Difficulty.  That  in  all  that  Space  of 
Time,  she  had  scarce  eat  so  much  as  would 
nourish  a  sucking  Child  ;  and  that  for  three 
Months  together  she  had  now  been  forced  to 
lie  constantly  on  her  Back,  not  daring  to  move  at 
all,  to  one  side  or  other.  This  tumour  was 
grown  to  so  monstrous  a  Bulk,  that  it  engrossed 


PERSE  CUTIONS. 


94 

the  whole  left  Side,  from  the  Umbilicus  to  the 
Pubes,  and  stretched  the  Abdominal  Muscles  to 
so  unequal  a  Degree,  that  I  do  not  remember 
to  have  ever  seen  the  like  in  the  whole  Course 
of  my  Practice.  It  drew  towards  a  point.  Her 
being  so  long  confined  to  lie  continually  on  her 
Back,  having  grievously  excoriated  her,  added 
much  to  her  Sufferings,  which,  with  want  of  Rest 
and  Appetite,  had  greatly  wasted  her. 

"  I  told  her,  that  in  order  to  effectually  relieve 
her,  I  must  lay  open  great  part  of  her  Belly, 
and  remove  the  Cause  of  all  that  Swelling :  She 
seemed  not  frightened,  but  heard  me  without 
Disorder,  and  pressed  me  to  the  Operation.  I 
drew  (I  must  confess)  almost  all  my  Confidence 
from  her  unexpected  Resolution,  so  that  with- 
out loss  of  Time  I  prepared  what  the  Place 
would  allow,  and  with  an  Imposthume  Lancet, 
laid  open  about  an  inch ;  but  finding  nothing 
issue,  I  enlarged  it  two  Inches,  and  even  then 
nothing  came  forth  but  a  little  thin  yellowish 
Serum  ;  so  I  ventured  to  lay  it  open  two  Inches 
more.  I  was  not  a  little  startled,  after  so  large 
an  Aperture,  to  find  it  stopped  only  by  a  glu- 
tinous Substance.  All  my  Difficulty  was  to 
remove  it ;  I  tried  my  Probe,  I  endeavoured 
with  my  Fingers,  but  all  was  in  vain  ;  it  was  so 


PERSECUTIONS.  95 

slippery  that  it  eluded  every  Touch  and  the 
strongest  Hold  I  could  take. 

"I  wanted  in  this  Place  almost  everything 
necessary,  but  bethought  myself  of  a  very  odd 
Instrument,  yet  as  good  as  the  best,  because  it 
answered  the  End  proposed.  I  took  a  strong 
Firr-splinter,  wrapped  some  loose  Lint  about 
the  End  of  it,  and  thrust  it  into  the  Wound,  and 
by  turning  and  winding  it,  I  drew  out  above  two 
Yards  in  Length  of  a  Substance  thicker  than 
any  Gelly,  or  rather  like  Glue  that  is  fresh  made 
and  hung  out  to  dry;  the  Breadth  of  it  was 
above  ten  Inches  :  This  was  followed  by  nine 
full  Quarts  of  such  Matter,  as  I  have  met  with 
in  Steatomatous  and  Atheromatous  tumours, 
with  several  HydatiUes  of  various  Sizes,  all  con- 
taining a  yellowish  Serum,  the  least  of  them 
bigger  than  an  Orange,  with  several  large 
Pieces  of  Membranes,  which  seemed  to  be  Parts 
of  the  distended  Ovary.  Then  I  squeezed  out 
all  I  could,  and  stitched  up  the  Wound  in  three 
Places,  almost  equi-distant : 

"  I  was  obliged  to  make  use  of  Lucatellus  s 
Balsam,  which  was  made  by  her  Lady  for  the 
Use  of  the  Poor ;  with  this  Balsam  I  covered  a 
Pledget,  the  whole  Length  of  the  Wound,  and 
over  that   laid  several  Compresses,  dipped   in 


^6  PERSECUTIONS. 

warm  French  Brandy,  and,  because  I  judged 
that  the  Parts  might  have  lost  their  Spring  by 
so  vast  and  so  long  a  Distention,  I  dipt  in  the 
same  Brandy  a  large  Napkin,  four  times  folded, 
and  applied  it  over  all  the  Dressings,  and  with 
a  couple  of  strong  Towels,  which  were  also 
dipt,  I  swathed  her  round  the  Body,  and  then 
gave  her  about  four  Ounces  of  the  following 
Mixture :  3^. — Aq.  menthce,  Ib.ss.  Aq.  cinna- 
momifort.  flbj.ss.  Syr.  Diacodii,  §vj. — M.  The 
Cinnamon  Water  was  drawn  off  from  Canary 
and  the  best  Cinnamon;  indeed  it  was  the 
finest  and  most  fragrant  Cinnamon  Water  I 
ever  tasted :  Of  this  Mixture  I  ordered  her  2 
or  3  Spoonfuls  4  times  a  Day. 

"Next  Morning  I  found  her  in  a  bathing 
Sweat,  and  she  informed  me,  with  great  Tokens 
of  Joy,  that  she  had  not  slept  so  much,  nor 
found  herself  so  well  refreshed  at  anytime  for 
three  Months  past. 

"I  carefully  attended  her  once  every  Day, 
and  as  constantly  dressed  her  Wound  in  the 
same  manner  as  above,  for  about  eight  Days 
together :  I  kept  in  the  lower  Part  of  the 
Wound  a  small  Tent,  which  discharged  some 
Serosities  at  every  Dressing  for  four  or  five 
Days.     But  Business  calling  me  elsewhere,  I 


PERSECUTIONS.  gy 

left  her,  having-  first  instructed  her  two  Daugh- 
ters how  to  dress  her  Wound,  and  told  them 
what  Diet  I  thought  most  proper. 

"  Her  chief  Food  was  strong  Broth  made  of 
an  old  Cock,  in  each  Porringer  of  which  was  one 
Spoonful  of  Cinnamon  Water;  this  was  re- 
peated 4  times  a  Day,  and  gave  her  new  Life 
and  Spirits. 

"After  three  Weeks  Absence  I  called  at  her 
House,  and  finding  it  shut  up,  was  a  little  sur- 
prised, but  had  not  gone  far  before  I  was  much 
more  surprised,  when  I  found  her  sitting 
wrapped  up  in  Blankets,  giving  directions  to 
some  Labourers  who  were  cutting  down  her 
Corn. 

"She  mended  apace,  to  the  Admiration  of 
everybody  thereabouts,  recovered  surprisingly, 
and  lived  in  perfect  Health  from  that  time,  until 
October,  i*]  14 ',  when  she  died  in  ten  Days' 
Sickness. 

"  That  this  Tumour,  or  rather  Dropsy,  of  the 
Ovarium  proceeded  from  the  Midwife's  Rash- 
ness in  pulling  away  the  Placenta,  not  knowing 
how  to  separate  it  from  the  Uterus  skilfully, 
seems  to  me  plain  from  what  the  Woman  her- 
self told  me,  and  what  fell  out  afterwards.  The 
Placenta  adhering  fast  to  the  Uterus,  required 
7 


o8  persecutions. 

more  Art  to  bring  it  away  than  she  was  Mis- 
tress of,  which  probably  induced  her  to  use 
Violence  ;  by  which  she  forced  down  the  Fundus 
Uteri ;  so  overstrained  the  Ligaments,  and  all 
that  is  appended  to  them  ;  especially  the  Liga- 
menttim  latum  of  the  left  Side,  and  its  Ovarium, 
which  may  be  reasonably  allowed  to  have  been 
hurt  in  the  Relaxation  with  the  rest.  Hence 
the  Elasticity  of  these  injured  Parts  was  not 
only  impaired,  but  the  small  Lymphatics  rup- 
tured, so  that  the  extravasated  Lympha  rushing 
out,  thickned,  and  not  being  able  to  recirculate, 
dilated  the  injured  Ovarium,  and  thus  increased 
the  Tumour,  and  the  Parts  being  already  ex- 
cessively distended,  and  being  no  longer  able 
to  resist  the  new  Influx  of  fresh  Secretions  rup- 
tured also,  and  by  degrees  augmented  to  that 
huge  and  enormous  Bulk." 

Professor  Helmuth,  after  citing  excerpts  from 
the  above  case,  goes  on  to  say:  "I  ask  those 
who  are  in  any  way  acquainted  with  the  subject, 
can  this  be  called  an  ovariotomy?  Mr.  Tait's 
reasoning  on  this  subject  is  most  peculiar;  he 
says:  'Although  he  (Houstoun)  does  not  de- 
scribe his  division  of  the  pedicle,  or  his  having 
tied  it,  it  is  almost  certain  that  he  did  both. 
He  certainly  must  have  seen  and  divided  the 


PERSECUTIONS.  gg 

pedicle,  for  he  describes  the  disease  as  being 
of  the  left  ovary,  therefore  he  saw  the  pedicle.' 
How  the  latter  conclusion  could  be  deduced 
from  the  former  expression  appears  to  me  to 
be  incredible.  The  disease  was  of  the  left 
ovary,  'therefore  he  saw  the  pedicle/  Mr.  Tait 
further  continues,  'perhaps  he  tore  it  and  it  did 
not  need  tying.'  ....  From  a  careful  reading 
of  all  this,  I  think  we  may  make  deductions 
entirely  antagonistic  to  those  of  Mr.  Tait,  and 
may  positively  say  that  Houstoun  did  not  per- 
form a  complete  ovariotomy It  has  been 

suggested  by  Dr.  R.  S.  Sutton,1  of  Pittsburgh, 
that  Dr.  Houstoun,  without  knowing,  enucle- 
ated the  cyst  and  directed  no  further  attention 
to  the  pedicle.  Peaslee2  simply  says,  *  Dr.  Hous- 
toun did  not  perform  ovariotomy.'  ....  With 
the  careful  understanding  of  all  these  circum- 
stances, we  hope  that  it  must  be  apparent  to 
every  one  that  Dr.  McDowell  still  holds  priority 
of  claim  in  the  performance  of  this  operation, 
and  we  must  still  dignify  him  with  the  title  of 
'  The  Father  of  Ovariotomy?" 

1  A  paper  read  at  the  meeting  of  the  American  Gynecological 
Society,  held  in  Boston,  1882. 

2  Ovarian  Tumors,  p.  227. 


CHAPTER  VII. 

DEATH  OF  DR.  EPHRAIM  McDOWELL. 

In  the  year  1830,  on  the  evening  of  the  20th 
of  June,  while  almost  in  the  prime  of  life,  Dr. 
Ephraim  McDowell  passed  from  earthly  scenes, 
peacefully  yielding  up  his  useful  and  well-spent 
life.  The  physicians  in  attendance  on  him  pro- 
nounced the  cause  of  dissolution  an  acute  attack 
of  inflammation  of  the  stomach.  His  illness, 
which  was  very  brief,  was  caused  by  eating 
strawberries.  It  was  a  habit  with  him,  when 
the  fruit  was  in  season,  to  go  into  his  garden 
and  gather  the  berries  fresh  from  the  vine,  and 
to  eat  of  them  freely.  On  this  occasion  he 
gathered  and  ate  a  good  many,  as  they  were 
unusually  fine  in  flavor  and  sweetness.  When 
he  returned  to  the  house  he  was  ill,  and  com- 
plained of  great  pain  with  nausea. 

Mrs.  McDowell  at  once  dispatched  a  servant 
for  the  family  physician,  who  shortly  arrived, 
and  seeing  the  critical  and  dangerous  condition 
of  his  patient  desired  a  fellow-practitioner  to  be 
summoned  with  view  to  consultation. 
( I0°) 


DEATH  OF  EPHRAIM  MCDOWELL.  yq>y 

The  case  was  diagnosed  and  treated  as  in- 
flammation  of  the  stomach,  but  Dr.  McDowell, 
agreeing- with  his  wife's  impressions,  told  them 
he  thought  he  had  eaten  a  poisonous  insect  or 
poisonous  eggs  that  had  been  deposited  upon 
the  berry.  The  physicians,  however,  did  not 
agree  with  the  suggestion  made,  but  treated 
the  case  in  accordance  with  their  diagnosis. 
The  patient  was  suffering  too  much  pain  to 
suggest  anything  that  might  have  a  tendency 
to  relieve  him,  and  in  a  short  time,  after  acute 
suffering,  he  expired,  surrounded  by  all  the 
members  of  his  family.  His  death  occurred 
toward  the  close  of  the  evening,  and  it  was  one 
of  the  most  heavenly  of  all  midsummer  twilights 
— fanned  as  it  was  by  zephyr  breezes,  the  spirit 
of  this  good  man  passed  to  the  God  that  had 
created  it. 

Dr.  McDowell  was  greatly  respected  in  life 
by  those  who  were  able  to  appreciate  his  many 
praiseworthy  qualities,  and  he  filled  an  honored 
grave.  His  shortcomings  were  few  while  his 
merits  were  many,  and  we  are  to  cover  gently 
with  the  "mantle  of  charity"  his  few  faults, 
knowing  as  we  do  his  many  virtues,  and  that 
these,  like  a  running  brook,  "will  live  on  and 
on    forever,"  until  the    remembrances  of  him 


! Q2     DEA  TH  OF  EPHRAIM  MC  DO  WELL. 

and  his  works  shall    swell  and  grow  like   the 
mighty  ocean. 

Could  the  countless  number  of  women  who, 
directly  or  indirectly,  have  been  relieved  from 
suffering  and  saved  from  an  untimely  grave 
through  the  benefaction  of  the  Kentucky  sur- 
geon, proclaim  with  one  voice  "McDowell  was 
my  salvation,"  the  mighty  echo  would  sound 
and  resound  from  pole  to  pole. 

The  brig-ntest  consolation  that  could  be 
offered  to  his  bereaved  and  heartbroken  family 
over  his  untimely  death  was  the  assurance  that 
his  earthly  career  had  been  such  that  when  the 
summons  came  to  him  that  his  spirit  presence 
was  desired  to  appear  before  the  Divine  Master, 
that  he  had  a  mission  in  the  heavenly  land  to 
fill,  he  was  ready  to  meet  it.  He  died  believ- 
ing firmly  in  the  atonement  of  the  blood  of  the 
Lamb,  the  resurrection  of  the  body  and  (to  the 
righteous)  life  everlasting. 

Although  at  times  his  bark  of  life  may  have 
been  tossed  upon  the  tempestuous  waves  of 
oppression,  and  his  spirit  sorely  tried,  yet  he 
was  never  known  to  take  the  name  of  God  in 
vain.  It  does  seem  that  his  heart  was  made 
perfect ;  tried  in  the  crucible  of  affliction. 
When  he  was  advised  by  his  physicians  that  if 


DEA TH  OF  EPHRAIM  MCDOWELL.  IQ^ 

he  had  any  business  affairs  to  arrange,  he  had 
better  attend  to  the  matter  before  it  was  too 
late,  he  quietly  said,  with  that  calm  Christian 
resignation  so  characteristic  of  the  closing 
hours  of  the  righteous  believer,  "  All  my  earthly 
affairs  are  satisfactorily  arranged,  and,  what  is 
of  more  importance  than  all  else,  my  peace  with 
God  is  made,  and  in  making  that  mysterious 
change  from  mortal  to  immortal  I  have  no  dread, 
for  I  can  truthfully  say,  '  though  I  walk  through 
the  valley  of  the  shadow  of  death  I  will  fear  no 
evil,  for  Thy  rod  and  Thy  staff  they  comfort 
me,'  and  I  feel  in  parting  with  my  beloved 
family  and  friends  that  my  life  has  been  devoted 
to  their  cause,  that  it  has  been  the  cherished 
object  of  my  life  to  relieve  suffering  humanity ; 
and  I  close  my  eyes  in  death  forgiving  those 
who  have  done  me  any  injustice,  and  with  the 
happy  and  peaceful  assurance  of  soon  being 
with  Him  who  has  ever  guided  my  earthly  pil- 
grimage, who  forgiveth — "  Before  he  could 
finish  the  sentence  death  had  silenced  his  lips 
forever. 

A  great  and  noble  man  had  fallen — but  not 
to  be  forgotten.  His  remains  were  interred 
in  the  family  burying  ground  at  "Traveller's 
Rest"  (the  homestead  of  Gov.  Isaac  Shelby). 
There  they  rested  several  decades  undisturbed. 


I04  DEA TH  OF  EPHRAIM  MCDOWELL. 

He  left  his  family  comfortably  provided  for ; 
but  had  he  possessed  any  mercenary  qualities 
he  could  have  amassed  a  large  fortune.  It  was 
contrary  to  his  nature,  however,  to  "  save  up." 
His  acts  and  sentiments  of  pure  philanthropy 
and  generosity  were  too  extensive  to  have  per- 
mitted any  great  accumulation  of  worldly  pos- 
sessions, though  his  practice  was  extensive  and, 
we  might  add,  lucrative.  He  was  an  especial 
friend  to  the  needy  and  oppressed,  and  his 
many  acts  of  benevolence  naturally  diminished 
his  income. 

Instead  of  avoiding,  he  sought  out  objects  of 
charity,  and  was  frequently  known  to  go  on 
missions  of  mercy  during  the  night,  and 
to  travel  several  miles  to  see  a  sick  patient 
when  he  had  any  doubts  about  a  case,  know- 
ing- at  the  time  that  he  could  never  realize, 
in  the  way  of  his  purse,  anything  for  his  profes- 
sional services.  But  the  desire  and  feeling  to 
do  good  were  innate  with  him;  emanating 
from  the  noble  impulses  of  a  just  and  upright 
man,  who  was  utterly  void  of  selfish  motives. 

What  property  he  left  was  judiciously  dis- 
posed of  in  a  brief  will.  He  bequeathed  his 
beautiful  homestead  to  his  only  son,  retaining 
a  life-interest  in  it  for  his  wife.  His  daughters 
were  provided  for  equally  with  the  son. 


DEA  TH  OF  EPHRAIM  MCDOWELL.  105 

Mrs.  McDowell  realizing  her  utter  desolation 
in  the  great  bereavement  experienced  in  the 
death  of  her  husband,  and  not  wishing  to  incur 
the  responsibility  of  "farming,"  removed  to 
Danville.  Depressed  by  a  sense  of  loneliness 
(for  his  place  could  never  be  filled)  she  decided 
to  spend  the  remaining  days  of  her  declining  life 
with  her  daughter,  Mrs.  Anderson,  who  was 
ardently  attached  to  her  mother. 

It  was  at  the  home  of  Mrs.  Anderson,  eighteen 
years  after  the  death  of  the  Doctor,  that  Mrs. 
McDowell  passed  away.  Her  death  was  deeply 
regretted.  She  had  carried  on  the  charitable 
work  which  her  lamented  husband  had  inaugoi- 
rated  so  many  years  previously,  and  her  death 
fell  heavily  upon  that  class  of  people  who  were 
recipients  of  her  goodness.  She  fully  seconded 
the  purposes  of  her  deceased  husband,  for  no 
one  ever  heard  either  him  or  her  say  to  the 
needy  and  destitute  "be  ye  warmed  and  be  ye 
clothed,"  without  at  the  same  time  seeing  fur- 
nished by  them  needed  means  for  relief  of 
the  necessities. 

The  remains  of  the  wife  were  placed  beside 
those  of  her  husband,  in  the  family  burying 
ground  six  miles  from  Danville.  There  both 
bodies    remained    undisturbed    until   the  year 


io6  DEATH  OF  EPHRAIM  MCDOWELL. 

1879,  when  that  of  Dr.  McDowell  was  removed 
to  Danville  and  reinterred  in  the  place  desig- 
nated by  the  Monumental  Committee,  which 
spot  was  appropriately  selected  near  the  monu- 
ment erected  to  his  memory  by  the  Medical 
Association  of  Kentucky.  A  question  then 
arose  (causing  considerable  controversy)  re- 
garding the  propriety  of  removing  Mrs.  Mc- 
Dowell's remains  and  placing  them  beside 
those  of  her  husband.  Was  it  right  to  separate, 
even  in  death,  the  persons  of  husband  and 
wife  ?  The  bodies  had  rested  many  years  side 
by  side.  Should  this  not  continue  ?  To  take 
a  benign  view  of  the  question,  one  can  but  be 
impressed  with  the  solemnity  of  the  position. 
The  physicians  met  in  council  and  decided  to 
refer  the  matter  to  Dr.  J.  N.  Toner,  of 
Washington  City.  Dr.  Toner  having  read  and 
remembered  the  controversy,  together  with  the 
decision  rendered  at  the  time  of  the  reinter- 
ment of  the  remains  of  Mrs.  Washington,  the 
trouble  the  Committee  had  to  procure  the 
consent  of  the  authorities  in  power  at  that 
time  to  place  the  remains  of  Mrs.  Washing- 
ton beside  those  of  her  distinguished  husband 
at  Mount  Vernon,  he  took  the  same  stand 
in    the    question    referred    to    him    that    the 


DEATH  OF  EPHRAIM  MCDOWELL.  loy 

Committee  did  at  the  time  of  the  removal  of 
the  remains  of  the  President's  wife.  Conse- 
quently he  was  not  long  in  deciding  that  it 
was  proper  and  in  accord  with  an  instinctive 
sentiment,  that  Mrs.  McDowell's  body  should 
be  placed  beside  that  of  her  husband.  This 
decision  was  accepted  and  immediately  acted 
on,  and  the  wife  now  rests  in  the  "  McDowell 
Monumental  Grounds.  "  Two  conspicuous 
green  mounds,  placed  side  by  side  to  the 
right  of  the  shaft,  mark  the  places  of  interment. 
All  credit  is  due  Dr.  Toner  for  his  wise  and 
humane  decision. 


CHAPTER    VIII. 

CRITICISMS    AND    COMMENTS. 

Addenda  in  the  shape  of  criticisms  and 
comments  relative  to  Dr.  McDowell,  his  opera- 
tions and  times,  will  hardly  lack  interest  to 
the  enlightened  and  less-selfish  physician  of 
the  present  age:  criticisms  on  the  then  mur- 
derous ovariotomy,  and  bitter  sarcasm  hurled 
at  "the  father  of  ovariotomy."  For  most  of 
these  items  we  are  indebted  to  reliable  and 
prominent  European  and  American  surgeons. 

Dr.  Ezra  Michener,  of  Philadelphia,  in  an 
article  in  the  journal1  containing  Dr.  McDowell's 
reports,  after  saying,  "It  is  much  to  be  regretted 
that  cases  so  interesting  to  the  community  as 
those  of  Dr.  McDowell,  and  as  novel  as  inter- 
esting, should  come  before  the  public"  in  such 
a  manner  as  to  frustrate  the  intention  of  becom- 
ing useful,"  and  expressing  a  hope  that  they 
really  are  "correctly  stated,"  sarcastically  quotes 
what  is  said  in  the  report  of  the  first  case 
respecting  the  effects  of  the  horn  of  the  side- 
eclectic  Repertory,  Jan.,  1818,  vol.  viii.,  No.  22,  p.  114. 
(108) 


CRITICISMS  AND  COMMENTS. 


1 00 


saddle,  and  the  patient  being  engaged  in 
making  her  bed  on  the  fifth  day,  and  closes 
thus:  "The  utter  impossibility  of  our  ever 
being  able  to  ascertain,  with  certainty,  the  real 
nature  of  those  internal  diseases,  the  delusive 
nature  of  all  their  indications,  and  the  necessary 
danger  of  an  operation  under  the  most  favorable 
circumstances,  will  be  likely  to  prove  an  insur- 
mountable barrier  to  the  use  of  the  knife  in 
their  removal,  as  few  persons  will  be  likely  to 
risk  their  reputation  on  such  uncertain  data." 

Dr.  Washington  L.  Atlee,  in  referring  to  the 
early  history  of  ovariotomy,1  says:  "In  1853 
Joshua  B.  Flint,  M.D.,  of  Louisville,  Professor 
of  Surgery  in  the  Kentucky  School  of  Medicine, 
presented  a  report  on  Surgery  to  the  State 
Medical  Society,  in  which  he  outraged  pro- 
fessional ethics  in  his  opposition  to  ovarioto- 
mists  ....  unjustly  denouncing  McDowell. 

"It  is  well  known  that,  from  the  earliest 
period  of  ovariotomy  in  Philadelphia  down  to 
the  present  time,  it  has  been  my  invariable 
custom  to  invite  members  of  the  profession 
to  witness    the  operation    in    order  that   they 

1  Annual  Address  before  the  Philadelphia  County  Medical 
Society,  delivered  February  1,  1875.  (Bound  in  Diseases  and 
Surgery  of  the  Uterus  and  Ovaries,  No.  4,  1103,  Library  of 
Philadelphia  College  of  Physicians.) 


z  IO  CRITICISMS  AND  COMMENTS. 

might  be  able  to  form  a  proper  opinion  of  its 
character  and  to  judge  of  its  propriety. 

"There  was  not  a  prominent  medical  gentle- 
man in  this  city  that  had  not  such  an  oppor- 
tunity. It  was  a  rare  circumstance  during  the 
probationary  stage  of  the  operation  for  any  one 
to  accept  the  invitation  cordially  and  gratefully. 
Others  positively  refused  and  emphatically  con- 
demned the  innovation,  while  others  took  the 
invitation  as  an  insult. 

"Gentlemen  who  were  bold  enough  to  witness 
the  manipulations  were  even  directly  accused 
by  their  professional  acquaintances  of  being 
'particeps  criminis'  in  committing  murder  ;  not- 
withstanding, these  murdered  patients  recov- 
ered. Some,  high  in  the  profession,  against  all 
ethical  considerations,  would  call  upon  patients 
who  had  fully  decided  upon  the  operation,  for 
the  purpose  of  warning  them  against  me  and 
certain  death. 

"The  day  before  I  operated  upon  my  first 
patient  in  Philadelphia  an  eminent  surgeon 
called  upon  her,  to  assure  her  that  she  would 
certainly  be  dead  in  twenty-four  hours. 
Twenty-four  hours  after  the  operation  I  re- 
quested him  to  see  her,  and  the  condition 
was    such    that    he    would    not    believe    she 


CRITICISMS  AND  COMMENTS. 


Ill 


had  been  meddled  with  until  I  exposed  the 
wound. 

"The  colleges,  as  stated,  proclaimed  fiercely 
against  the  operation  as  unjustifiable  and  crim- 
inal. Sometimes  the  professors  would  go  out 
of  their  way  to  denounce  it.  One  eminent 
surgeon,  now  dead,  after  the  occurrence  of  a 
fatal  case  in  1851,  opened  his  lecture  on  sur- 
gery in  words  like  these:  'Gentlemen,  it  is 
my  painful  duty  to  announce  to  you  that  a  re- 
spectable lady  who,  a  few  days  ago,  came  from 
New  York  to  this  city  with  an  ovarian  tumor, 
which  was  removed  by  Dr.  Atlee,  returned  to 
that  city  to-day  a  corpse.'  This  was  particu- 
larly marked,  as  it  had  no  relation  to  the  sub- 
ject of  that  lecture.  It  was  not  uncommon  for 
medical  men  to  refuse  to  meet  me  in  consulta- 
tion, for  no  other  reason  than  my  persistence 
in  performing  ovariotomy. 

"A  prominent  surgeon,  then  belonging  to  the 
staff  of  the  Pennsylvania  Hospital,  upon  being 
called  out  at  night  to  see  one  of  my  patients, 
when  I  was  sick  in  bed,  after  prescribing  and 
without  his  having  been  solicited  to  join  in  the 
treatment  of  the  case,  voluntarily  said,  'Tell 
Dr.  Atlee  that  I  will  not  meet  him  in  consulta- 
tion, because  he  undertakes  to  perform  opera- 


II2  CRITICISMS  AND  COMMENTS. 

tions  not  recognized  by  the  profession.'  An- 
other, in  passing  along  Arch  Street,  opposite 
my  house,  in  company  with  others,  exclaimed, 
'There  lives  the  greatest  quack  in  Philadelphia.' 
And  yet  this  same  gentleman  is  now  an  ova- 
riotomist  himself.  Even  my  own  colleagues, 
with  the  exception  of  Professor  Grant,  discoun- 
tenanced the  operation,  and  endeavored  to  con- 
vince me  of  my  error. 

"I  need  not  dwell  any  longer  on  these  early 
phases  of  the  history  of  ovariotomy.  Ovari- 
otomy, both  privately  and  publicly,  was  de- 
nounced without  measure,  and  the  weight  of 
the  battle  axe  in  this  city  fell  upon  my  shoul- 
ders.'' 

Dr.  Atlee  says  :  "  I  commenced  studying  the 
literature  of  the  operation,  and  soon  realized 
the  bold  and  important  step  taken  thirty-four 
years  before  by  Dr.  McDowell,  of  Kentucky. 

"In  speaking  of  Dr.  Clay,  of  Manchester,  Dr. 
Bird,  of  London,  and  Dr.  Washington  L.  Atlee, 
of  our  own  country,  Dr.  Flint  says:  'It  is  cer- 
tain that  neither  of  them  has  attained  to  the 
position  of  an  authority  in  the  commonwealth 
of  surgery,  and  the  force  of  their  testimony  to 
the  propriety  and  value  of  the  operation  (ova- 
riotomy) is,  moreover,  very  much  impaired  by 


CRITICISMS  AND  COMMENTS.  j  1 3 

the  suspicious  attitude  in  which  they  stand  to 
it  in  having  made  it  a  sort  of  specialty,  than 
which  nothing  is  more  trying  to  professional 
integrity.  ' 

"The  same  opposition,  although  not  so  acrid 
and  determined,  assailed  the  operation  and  its 
advocates  in  other  countries.  In  an  innovation 
so  momentous,  this,  perhaps,  was  best.  For 
my  own  part  I  was  and  am  satisfied.  I  believe 
my  opponents  were  honest  in  their  convictions. 
I  know  that  I  was,  and  as  my  actions  were 
based  upon  abundant  study  of  the  subject  in 
all  its  aspects,  upon  repeated  facts  constantly 
recurring,  and  upon  the  success  attending  those 
who  practised  ovariotomy,  I  felt  assured  that 
this  great  battle  must  terminate  in  favor  of 
science  and  humanity." 

These  extracts  from  Dr.  Atlee  show  the  un- 
merited opprobrium  visited  upon  those  who 
had  the  boldness  and  the  temerity  to  perform 
ovariotomy.  The  struggle  against  professional 
prejudice  was  hard,  and  verifies  the  words  of 
Bacon:  "If  a  man  perform  that  which  hath  not 
been  attempted  before,  or  attempted  and  given 
over,  or  hath  been  achieved  but  not  with  so 
good  circumstances,  he  shall  purchase  more 
honor   than    by  affecting  a  matter  of  greater 


j  1a  CRITICISMS  AND  COMMENTS. 

difficulty,   or  virtue,  wherein    he  is    but   a  fol- 
lower." 

Dr.  Charles  D.  Meigs,  Professor  of  Obstet- 
rics, etc.,  in  the  Jefferson  Medical  College  of 
Philadelphia,  denounced  McDowell  in  the  bit- 
terest terms,  and,  in  the  presence  of  a  number 
of  medical  students,  boldly  asserted  that  there 
was  not  a  word  of  truth  in  what  McDowell  had 
reported  in  the  Eclectic  Repertory.  A  young 
student  from  Danville  was  present  when 
Dr.  Meigs  made  these  remarks,  and  a 
few  days  afterward  meeting  Dr.  John  L.  Atlee, 
told  him  that  Dr.  Meigs  was  entirely  wrong 
in  what  he  had  said  and  very  unjust  in  the 
denunciation  of  Dr.  McDowell  and  his  abdomi- 
nal operation  ;  for  he  had  frequently  heard  his 
father  say  that  Dr.  McDowell  certainly  per- 
formed ovariotomy  successfully ;  and  it  was  fur- 
thermore true  that  McDowell  did  all  he  claimed 
in  the  surgical  line,  and  that  his  reports  were 
true.  No  man  in  the  community,  save  the 
prejudiced  and  ignorant,  he  said,  where  Dr. 
Ephraim  McDowell  resided  would  ever  ques- 
tion his  veracity,  for  both  the  acts  and  life  of 
the  man  were  above  reproach.  No  citizen,  he 
added,  was  more  respected  for  his  truthful 
candor  and  conscientious  principles. 


CRITICISMS  AND  COMMENTS.  j  t  5 

Dr.  Atlee  listened  attentively  to  all  that 
the  student  had  to  say  in  defence  of  Dr. 
McDowell.  A  few  weeks  afterward,  being 
called  to  see  a  patient  who  had  an  ovarian 
tumor,  he  was  led  to  ask  himself  why  he,  Dr. 
Atlee,  could  not  repeat  what  he  accepted  as 
having  been  done  by  Dr.  McDowell?  The 
thought  suggested  to  his  mind  was  that 
"here  was  his  opportunity,"  and  after  reading 
carefully  the  report  of  Dr.  McDowell's  cases 
he  concluded  to  make  the  operation  upon  his 
patient,  which  he  did  with  happy  results.  The 
lady  recovered,  and  ''ovariotomy"  was  again 
and  again  performed  by  Drs.  Washington  L. 
and  John  L.  Atlee  with  remarkable  success. 

In  a  treatise  on  Diseases  of  Women  by  Lawson 
Tait,  F.R.C.S.,  published  in  1879,  the  seventh 
chapter  is  devoted  to  a  consideration  of  the 
ovaries.  Of  course,  all  forms  of  disease  then 
known  in  these  organs  are  described.  A 
number  of  ovariotomies  are  detailed,  done  not 
only  by  the  author  of  this  book,  but  by  a  large 
number  of  others  who  have  reported  on  the 
subject.  A  careful  reading  of  the  text  fails  to 
disclose  even  the  name  of  Ephraim  McDowell, 
to  whose  genius  the  world  now  accords  all  the 
blessings  brought  to  humanity  by  ovariotomy. 


H6  CRITICISMS  AND  COMMENTS. 

In  the  fourth  edition  of  Mr.  Tait's  work, 
Diseases  of  the  Ovaries,  published  in  1883,  com- 
mencing on  page  242,  speaking  of  William 
Hunter  and  his  brother  John,  and  also  of 
Houstoun,  the  author  says  :  "  Their  friend  John 
Bell,  who  practised  in  Edinburgh  from  1 790  till 
18 1 6,  also  pronounced  in  favor  of  its  perform- 
ance, but  he  is  not  known  to  have  done  anything 
toward  trying  it  himself,  and  it  is  to  a  young 
Scotchman,1  who  was  a  pupil  of  John  Bell's  in 
1 793,  that  we  owe  the  revival  of  the  operation 
and  its  performance  upon  a  scale  which  amount- 
ed to  that  of  a  legitimate  experiment.  Ephraim 
McDowell  has  been  honored  by  the  medical 
profession  in  America  as  the  'Father  of  Ovari- 
otomy,' and,  whether  we  admit  the  accuracy  of 
the  title  or  not,  there  can  be  no  doubt  that  it 
was  in  the  backwoods  of  Kentucky  that  abdom- 
inal surgery  received  one  of  its  greatest  im- 
pulses. 

"In  1809,"  says  Mr.  Tait,  "the  second  ovari- 
otomy was  performed  successfully,  and  the 
patient  survived  it  thirty- two  years.  In  181 7 
Dr.   McDowell    published  an   account  of   this 

1  "  My  American  readers  may  object  that  McDowell  was  not 
born  in  Scotland.  Of  this,  however,  we  are  not  yet  clear.  At 
any  rate,  his  father  and  mother  were  Scotch,  and,  at  the  time  of 
his  birth,  1771,  the  States  did  not  exist." 


CRITICISMS  AND  COMMENTS.  l  j  y 

and  of  two  other  cases  he  had  performed,  and, 
as  might  be  expected,  his  statements  were 
received  with  general  incredulity 

"For  some  ten  or  twelve  years  after  the  death 
of  Dr.  McDowell,  and  after  the  failures  of 
Lizars,  ovariotomy  seems,  by  common  consent, 
to  have  been  discontinued. 

"In  March  [May  8Z],  1836,  Dr.  Jeaffreson, 
of  Framlingham,  removed  a  parovarian  tumor 
successfully.  .  .  .  . 

"In  1838,  Mr.  Crisp,  of  Harleston,  and  Mr. 
West,2  of  Tunbridge  [November  2,  i8jy3~\,  also 
had  successful  cases,  but  they  were  clearly  all 
parovarian  and  not  ovarian  tumors 

"On  September  27  [i2tk'r\,  1842,  Dr. 
Charles  Clay,  of  Manchester,  who  may  in  all 
truth  be  regarded  as  the  'Father  of  Ovariotomy' 
as  far  as  Europe  is  concerned,  performed  his 
first  operation  for  the  removal  of  a  diseased 
ovary [The  italics  are  ours,  M.  Y.  R.] 

"Previous  to  September,  1842,  we  have, 
therefore,  records  of  only  two  ovariotomies, 
properly  so-called,  in  this  country — those  of 
Houstoun    and    Lizars 

1  Trans.  Prov.  Med.  and  Surg.  Assoc,  1837,  vol.  v.,  p.  239. 

2  Lancet,  Jan.  1837-38.  3  Ibid.  1837-38,  vol.  i.,  p.  307. 

4  British  Record  of  Obstetric  Medicine,  vol.  i.,  p.  179,  et  seq., 
and  Medico-Chirurgical  Review,  October,  1843. 


1 1 8  CRITICISMS  AND   COMMENTS, 

"Looking  back  upon  the  work  of  a  genera- 
tion now  almost  passed,  from  a  standpoint 
altogether  free  from  personal  bias,  I  have  no 
hesitation,  whatever,  in  ascribing  to  Dr.  Clay  by 
far  the  larger  share  of  the  credit  which  arises 
from  the  enormous  advances  made  in  ab- 
dominal surgery  during  the  last  forty  years. 

"It  is  quite  true  that  McDowell  was  the  first 
to  do  a  number  of  ovariotomies,  and  it  is 
equally  true  that  Houstoun  was  the  first 
successfully  to  remove  a  diseased  ovary,  but  it 
was  Clay,  of  Manchester,  who  first  showed  that 
ovariotomy  could  be  made  an  operation  more 
justifiable  by  its  results  than  any  of  the  major 
operations  of  surgery."   .... 

In  conceding  to  Mr.  Tait  the  last  word  on 
the  subject,  it  will  not  be  unfair  to  refer  to  his 
inconsistency  in  admitting  that  "McDowell  was 
the  first  to  do  a  number  of  ovariotomies  " — 
\_first  operation,  December  ij,  i8og\  claiming 
him  as  a  "young  Scotchman,"  etc,  and  then 
classifying  Houstoun's  removal  of  a  "  diseased 
ovary"  \_August,  i/Oi~\  as  an  ovariotomy — 
"properly  so-called,"  so  as  to  establish  Hous- 
toun as  the  first  ovariotomist. 

Mr.  Tait's  argument  in  favor  of  Dr.  Mc- 
Dowell's   Scotch    birth     is    predicated     upon 


CRITICISMS  AND  COMMENTS.  119 

the  fact  that  the  United  States  did  not  exist  in 
1 77 1.  It  might  be  well  to  mention,  however, 
that  the  territory  now  known  as  the  "  United 
States"  constituted  an  exceedingly  firm  and 
substantial  portion  of  that  terra  firma  known 
as  the  North  American  continent,  even  prior  to 
that  year,  and  that  McDowell  had  originated  an 
exceedingly  important  and  praiseworthy  surgi- 
cal procedure  might  easily  be  inferred  by  even 
the  readers  of  Mr.  Tait's  voluminous  writings, 
from  the  fact  that  Mr.  Tait  himself  makes  his 
proudest  boast  upon  his  superior  success  in 
the  performance  of  the  same  work  that  Dr. 
McDowell  gave  to  the  surgical  profession. 

We  are  to  be  permitted  to  correct  a  state- 
ment made  by  Mr.  Tait.  Dr.  Ephraim  Mc- 
Dowell's parents  were  not  born  in  Scotland. 
His  father,  Judge  Samuel  McDowell,  first  saw 
the  light  in  Pennsylvania,  while  his  mother, 
Mary  McClung,  was  a  native  of  Ireland. 

Mr.  Tait  does  not  seem  to  have  been  cor- 
rectly informed  regarding  several  facts  relat- 
ing to  Ephraim  McDowell,  otherwise  he  has 
allowed  his  prejudices  to  run  away  with  truth 
and  justice.  But  we  are  to  say  this  much,  had 
Dr.  McDowell  not  opened  the  abdomen  Mr. 
Tait's  "laparotomy"  might  yet  be  slumbering. 


120 


CRITICISMS  AND  COMMENTS. 


In  a  valuable  work  entitled  Ovarian  Tumors, 
by  E.  Randolph  Peaslee,  M.D.,  LL.D.,  pub- 
lished in  1872,  will  be  found,  in  Part  II. ,  com- 
mencing on  page  225,  a  history  of  ovariotomy, 
from  which  the  following  excerpts  are  made. 
[The  italics  are  ours,  M.  Y.  R.] 

In  the  United  States  :  "Dr.  Alban  G.  .Smith, 
who  was,  also,  a  practitioner  at  Danville  [Ken- 
tucky], and  assisted  Dr.  McDowell,  states  that 
the  latter  performed  ovariotomy  thirteen  times, 
in  all,  and  that  eight,  at  least,  of  these  opera- 
tions were  sucessful.  \_Dr.  Ephraim  McDowell's 
first  operation  was  on  December  ij,  i8og7\ 

"The  next  ovariotomist  in  this  country,  after 
Dr.  McDowell,  was  Dr.  Nathan  Smith,  then 
Professor  of    Surgery  in  Yale   College,  New 

Haven,     Connecticut This     operation 

"was  performed  at  Norwich,  Vermont,  on  the 
5th  of  July,  182 1.1   .   .   .   . 

"The  third  successful  ovariotomist  in  this 
country  was  Dr.  Alban  G.  Smith,  of  Danville, 
Kentucky,  whom  I  have  already  mentioned  in 
connection  with  the  operations  of  Dr.  E.  Mc- 
Dowell. His  operation  was  performed  May 
23  \or  2f\  1823 

1  American   Journal  of   Medical    Sciences,  April,  1851,  and 
Edin.  Med.  and  Surg.  Journ.,  October,  1822,  vol.  xviii.,  p.  532. 

2  North  American  Med.  and  Surg.  Journ.,  1826,  vol.  i.,  p.  30. 


CRITICISMS  AND  COMMENTS.  j  2 1 

"The  fourth  who  attempted  ovariotomy  in 
this  country  was  Dr.  Joseph  A.  Gallup,  Pro- 
fessor in  the  Medical  College  at  Woodstock, 
Vermont.     This  operation  was  performed  June 

12,    1824.1    .... 

"In  April  [20],  1827,  Dr.  Trowbridge,  of 
New  York,  attempted  ovariotomy,  but  desisted 
on  account  of  adhesions.2  .... 

"In  July,  1828,  Dr.  R.  D.  Mussey,  Professor 
of  Surgery  in  the  Medical  Department  of 
Dartmouth  College,  attempted  ovariotomy  at 
Ryegate,  Vermont.3  .... 

"  Dr.  J.  Bellinger,  of  Charleston,  South  Caro- 
lina, also  attempted  ovariotomy  in  1828 

"The  fourth  who  actually  performed  ovari- 
otomy in  the  United  States,  was  Dr.  David  L. 
Rogers,  still  residing  in  New  York,  where  his 
operation  was  performed  September  24*  [or 
//],  1829 

"Dr.  J.  C.  Warren,  Professor  of  Surgery, 
Boston,    attempted  ovariotomy   in   November, 


1  New  England  Journ.  of  Med.  and  Surg.,  Oct.,  1825,  p.  358. 

2  Boston  Medical  Intelligencer,  1827,  vol.  v.,  p.  337. 

3  American  Journ.  of  Med.  Sciences,  1837,  vol.  xxi.,  p.  380. 

4  New  York  Med.  and  Physical  Journal,  1830,  vol.  ii.,  p.  284. 

5  London  Medical  Gazette,  1829. 

6  Warren  on  Tumors,  p.  589. 


122 


CRITICISMS  AND  COMMENTS. 


"In  December  [2j],  1835,  Dr.  J.  Bellinger, 
successfully  performed  the  operation  of  ovari- 
otomy.1 ....  From  that  time  there  was  no 
case  of  ovariotomy,  in  this  country,  until  the 
year  1843,  when  Dr.  A.  Dunlap  and  Dr.  J.  L. 
Atlee  had  their  first  cases,  the  former  an  un- 
successful one. 

"Thus  it  appears  that  ovariotomy  in  this 
country,  originating  here  in  1809,  remained 
exclusively  in  the  hands  of  its  originator  \_Dr. 

Ephi'aim    McDowell~\   till     182 1 From 

this  time  to  1843,  though  several  times  at- 
tempted, it  was  actually  accomplished  only  by 
Dr.  Nathan  Smith,  Dr.  A.  G.  Smith  (who  had 
previously  assisted  Dr.  McDowell),  Dr.  Rogers, 
and  Dr.  Bellinger. 

"In  1843  and  1844,  a  new  impulse  was  given 
by  the  success  of  Dr.  J.  L.  Atlee,  and  which 
was  still  further  aided  by  his  brother,  Dr.  W. 
L.  Atlee 

For  the  history  of  ovariotomy,  in  the  United 
States,  subsequent  to  1843,  tne  reader  is  refer- 
red to  the  work  from  which  above  excerpts  are 
taken,  and  to  Dr.  Peaslee's  tables  of  statistics, 
pages  247,  248,  wherein  he  remarks  :   "  But  few 

1  Southern  Journal  of  Medicine  and  Pharmacy,  May,   1847,. 
vol.  ii.,  p.  241. 


CRITICISMS  AND  COMMENTS.  i2$ 

cases  of  ovariotomy  have  been  reported  by 
those  who  have  operated  most  frequently. 
....  But,  from  direct  correspondence,  I  am 
able  to  supply  the  deficiency,  to  a  great  extent, 

in  the  statistics  for  this  country This 

gives  a  total  of  six  hundred  and  sixty  opera- 
tions, and  four  hundred  and  fifty-three  successes, 
or  68.63  Per  cent Or,  a  total  up  to  Octo- 
ber 10,  1 87 1,  for  this  country  \_United  States~\, 
of  seven  hundred  and  thirty-nine  ovariotomies." 

In  Canada  (West):  "ovariotomy  was  per- 
formed, for  the  first  time,  in  i860,  by  Dr. 
Reginald  Henwood,  of  Brentford.  The  opera- 
tion was  successful."1.  .  .  . 

In  Scotland:  Mr.  Lizars  attempted  his  first 
case  in  ovariotomy  [October  24,  i82j2~\ 

"  His  subsequent  operations  were  on  Feb- 
ruary 27,  March  22,  and  April  24,  1825. 3 

"After  the  experience  of  Mr.  Lizars,  ovari- 
otomy was  entirely  discountenanced  in  Scotland, 
and  was  not  repeated  for  twenty  years  ;  and 
then,  in  1845  [September  f\,  by  Dr.  Handyside, 
of  Edinburgh.  For  thirty-seven  years,  or  up 
to  1862,  it  had  been  very  seldom  attempted  in 

1  American  Journ.  of  Med.  Sciences,  April,  1861,  p.  575. 
3  Edin.  Med.  and  Surg.  Journ.,  Oct.,  1824,  vol.  xxii.,  p.  247. 
s  Reported  on  pages  152  and  399-405  of  this  book. 


I24  CRITICISMS  AND  COMMENTS. 

that   country;   and   had   succeeded   only  in  a 
single  instance.1 

"In  Ireland,  also,  it  had  been  performed  but 
three  times  up  to  April,  1862  ;  and  always  with 
a  fatal  result"2 

In  England :  "  Dr.  Granville,  of  London,  twice 
attempted  ovariotomy,  in  1826  \_Jtdy  i~\  and 
1827  [March  2i~\.  The  last  of  these  two 
cases  proved  to  be  a  uterine  tumor,  and  the 
other  was  abandoned  on  account  of  adhesions.3 

"In  England  no  attempt  at  ovariotomy  had 
ever  been  made,  except  these  two  failures  of 
Dr.  Granville,  till  May  \8~\,  1836,  when  it  was 
successfully  performed  by  Mr.  William  Jeaffre- 
son,  of  Framlingham,  for  the  first  time  in  that 
country.4  In  this  year  two  other  successful 
operations  were  performed,  by  Mr.  King  \July 
12,  i8j6s~\y  and  Mr.  West  [November  2,  18 j76]. 
In  1838,  there  was  one  successful  operation  by 
Mr.  Crisp;  and,  in  1839,  another  by  Mr.  West, 
who,  also,  had  one  failure  this  year — this  last 

1  The  Lancet,  January,  1863,  p.  jo. 

2  American  Journ.  of  Med.  Sciences,  January,  1863,  p.  239. 

3  London  Medical  Gazette,  February  3,  1843,  v°l*  xxxi->  P-  672. 

4  Trans.  Prov.  Med.  and  Surg.  Asso.,  1837,  vol.  v.,  p.  239. 

5  Op.  cit.,  January,  1837. 

6  Lancet,  1837-38,  vol.  i.,  p.  307. 


CRITICISMS  AND  COMMENTS. 


125 


being  the  first  attempt  at  ovariotomy  in  a 
London  Hospital. 

"In  September  [9],  1840,  ovariotomy  was  first 
completed  in  a  London  Hospital,  by  Mr.  Ben- 
jamin Phillips,  but  the  patient  died.1 

"On  November  6,  1842,  Mr.  D.  H.  Walne, 
had  the  first  successful  case  of  ovariotomy  in 
London ;  the  large  incision,  also,  being  then 
made  for  the  first  time  in  the  metropolis.2  .... 

"  The  first  successful  operation  in  a  London 
Hospital  did  not  occur  till  [Sept.  223~\,  1 846 — Mr. 
Caesar  Hawkins  being  the  operator 

"Dr.  Charles  Clay,  of  Manchester,  com- 
menced his  career  as  an  ovariotomist,  Sep- 
tember 12,  1 842/ and  saved  three  out  of  four 
patients  this  year.  He  soon  became  the  most- 
distinguished  ovariotomist  living."  ....  To 
him,  "more  than  to  all  other  operators,  the 
credit  belongs  of  having  placed  the  operation 
of  ovariotomy  on  a  sure  foundation."  .... 

"Up  to  1866,  he  [Dr.  Charles  Clay]  had 
operated  one  hundred  and  thirty-seven  times, 
and  had  ninety-five  recoveries."  .... 

1  London  Med.  Gazette,  Oct.  9,  1840-41,  vol.  xxvii.,  p.  83. 
s  Obstetrical  Transactions,  vol.  v.,  p.  65. 

3  London  Med.  Gazette,  Oct.  9,  1840-41,  vol.  xxvii. ;  p.  65. 

4  British  Record  of  Obstetric  Medicine,  vol.  i.,  p.  179,  et  seq.t 
and  Medico-Chirurgical  Review,  October,  1843. 


I26  CRITICISMS  AND  COMMENTS. 

"  Dr.  Clay  was  graduated  at  the  University 
of  Edinburgh,  and  had  Mr.  Lizars  as  one  of 
his  preceptors.  He  commenced  practice  in 
1822,  and  therefore  had  had  twenty  years  of 
experience  as  a  surgeon  before  performing  his 
first  ovariotomy,  a  successful  case,  in  Septem- 
ber, 1842.  In  his  report  of  that  case  he  claims  to 
have  performed  the  first  operation  of  ovariot- 
omy in  England  by  the  long  incision  ;  which  dis- 
tinction is  also  asserted  for  him  by  Mr.  Walne.1 

"  Dr.  [James  R.]  Simpson,  of  Edinburgh,  was 
his  early  and  intimate  friend,  and  obtained  his 
ideas  of  ovariotomy,  which  he  so  eloquently 
defended  in  1846,  from  witnessing  many  of  Dr. 
Clay's  earlier  operations,  and  some  of  them  upon 
his  own  patients.  The  term  ova?/-iotomy  was  sug- 
gested by  Professor  Simpson  to  Dr.  Clay.  .   .  . 

"Taking  a  retrospect  of  his  own  labors  in 
connection  with  ovariotomy,  in  March,  1863, 
when  he  had  operated  one  hundred  and  eight 
times,  with  seventy  successes,  Dr.  Clay  thus 
expresses  himself:  ....  'Such  will  readily 
admit  that  a  rate  of  rather  more  than  seventy 
per  cent,  of  recoveries  is  a  victory  in  modern 
surgical  art  worth  contending  for.'2  .... 

1  London  Medical  Gazette,  December  16,  1842. 

2  Obstetrical  Transactions,  vol.  v.,  p.  65. 


CRITICISMS  AND  COMMENTS.  i2y 

[Sir]  "T.  Spencer  Wells  commenced  his 
career  as  an  ovariotomist,  in  February,  1858, 
and  which  must,  probably,  ever  remain  unri- 
valled, he  having  in  less  than  fourteen  years, 
up  to  September  1,  1871,  performed  the  oper- 
ation of  ovariotomy  four  hundred  and  forty 
times.".  .  .  . 

[328  cases  cured,  112  died,  recoveries  74.54 
per  cent.] 

"In  this  year  (1863),  Dr.  Thomas  Keith,  of 
Edinburgh,  performed  his  first  operation  ;  and, 
up  to  January  1,  1872,  having  performed  one 
hundred  and  thirty-six  operations  [with  one 
hundred  and  eleven  recoveries],  he  has  attained 
to  the  highest  success  yet  achieved  in  Europe 
— 81.61  per  cent 

"The  whole  number  of  reported  cases  of 
ovariotomy,  in  Great  Britain,  up  to  December 
1,  1863,  is  three  hundred  and  seventy-seven,  of 
which,  two  hundred  and  twenty-eight,  or  60.68 
per  cent.,  were  successful,  and  one  hundred  and 
forty-nine  patients  died 

"  During  the  last  seven  years  (1863  to  1870) 
not  less  than  six  hundred  and  fifty  ovariotomies 
have  been  performed  in  Great  Britain,  making 
a  total  of  between  one  thousand  and  eleven 
hundred  operations.     [See  table,  page  137.] 


I28  CRITICISMS  AND  COMMENTS. 

"  In  France,  Delaporte  was  the  first  to  recom- 
mend the  operation  of  the  extirpation  of  the 
diseased  ovary,  in  1774.1   [1753]  .... 

"  Nothing  favorable  to  ovariotomy  was  pub- 
lished in  France,  excepting  the  thesis  by  Sam- 
uel Hartman  d'Escher,  in  1808,  up  to  the  year 
1844.  Sabatier  had  opposed  the  operation  by 
every  imaginable  argument.2  Boyer  considered 
its  feasibility  an  illusion,  and  says :  '  The  least 
reflection  suffices  to  show  the  danger  and  the 
impossibility  of  this  operation,  which  has  not 
been  practised,  and  probably  never  will  be.3 

"  Thejirst  operation  of  ovariotomy  in  France 
was  performed  on  April  29,  1844,  by  Dr. 
Woyerkowsky,  of  Quingez  (Doubs).4  .... 

"On  September  15,  1847,  the  second  opera- 
tion of  ovariotomy,  in  France,  was  performed  by 
M.  Vaullegeard,  of  Conde-sur  Noireau  (Cal- 
vados).5 ...  It  was  in  this  year  that  Velpeau 
pronounced  against  ovariotomy,  regarding  it 
as  an  indication  of  foolishness   and  an  act  of 


1  Memoires  de  l'Academie  de  Chirurgie,  1774,  tome  iv.,  p.  96. 

2  Medecine  Operatoire,  Ed.  Dupuytren,  vol.  ii.,  p.  503. 

3  Maladies  Chirurgicales,  vol.  viii.,  p.  45S. 

4  Journal  de  Medecine  et  de  Chirurgie  Pratique,  Paris,  1847. 

5  Journal  des  Connaissances  Medico-Chirurgicales,  Juin,  1848. 

6  Gazette  des  Hopitaux,  No.  99,  1847. 


CRITICISMS  AND  COMMENTS.  I2g 

"Up  to  this  time  [1856-57]  ovariotomy  had 
been  completed  but  four  times  in  France — 
twice  successfully,  and  twice  unsuccessfully. 
....  In  the  meantime,  in  this  country  [United 
States],  the  operation  had  been  performed,  up 
to  the  close  of  1856,  ninety-seven  times,  and 
fifty-four  times  successfully  ;  in  England,  one 
hundred  and  twenty-three  times,  with  seventy- 
one  recoveries  ;  and  in  Germany,  forty-seven 
times,  with  but  thirteen  cures,  and  thirty-four 
deaths [See  tables,  pages  136,  137,  and 

138.] 

"  In  these  circumstances  it  is  not,  at  first, 
easy  to  account  for  the  opposition,  and  even 
the  virulence,  manifested  so  generally,  by  the 
members  of  the  French  Academy  of  Medicine, 
against  this  operation.  The  discussion  on  ova- 
rian cysts  and  their  treatment  was  commenced 
in  October,  1856,  and  continued  till  the  next 
February,1  the  following  members,  half  of 
them  eminent  surgeons,  participating  in  it : 
Velpeau,  Cruveilhier,  Cloquet,  Jobert  (de 
Lamballe),  Malgaigne,  Huguier,  Guerin,  Gim- 
elle,  Trousseau,  Piorry,  Moreau,  Robert,  Barth, 
and  Cazeaux.    With  a  single  exception,  all  these 

1  Reported  in  the  Bulletin   de  l'Academie  Imperiale,  from 
October,  1856,  to  February,  1857. 

9 


1 20  CRITICISMS  AND  COMMENTS. 

gentlemen  condemned  ovariotomy  as  a  rash, 
unjustifiable  procedure. 

Dr.  Peaslee  continues:  "I  will  quote  from 
several  of  the  surgeons  just  mentioned,1  merely 
premising  that  Piorry,  a  physician,  admitted 
that  'in  certain  circumstances  we  might  attempt 
the  excision  of  ovarian  tumors  ;  but  to  do  this 
one  must  possess  an  American  audacity '  (une 
audace  Americaine.') 

"  Malgaigne  :  'A  great  deal  has  been  said  in 
America  and  in  France  respecting  the  extirpa- 
tion of  ovarian  cysts  ;  an  operation  too  radical, 
as  it  seems  to  me,  and  of  a  nature  to  place 
patients  too  absolutely  beyond  all  resource.  .  . 
The  alleged  statistics  prove  nothing.  All  know 
what  statistics  are  worth  when  all  the  successes 
are  collected,  and  the  reverses  are  omitted.' 

"  Cruveilhier  :  '  There  is  no  curative  for  mul- 
tilocular  cysts,  for  there  can  be  but  one  method 
of  cure,  and  that  by  extirpation.  And,  although 
this  operation  may  be  invited,  to  some  degree, 
by  the  isolation  of  the  cyst,  the  perfect  integ- 
rity of  the  surrounding  organs,  and  the  facility 
of  the  operative  procedure,  although  it  has 
been  performed  quite  a  large  number  of  times 

1  Sessions  of  November  6,  13,  and  20,  1856.  Bulletin  de 
l'Academie  Imperiale,  tome  ii.,  p.  25. 


CRITICISMS  AND  COMMENTS.  l  •,  l 

with  success,  especially  in  England  and  in 
America,  I  do  not  think  that  this  daring  opera- 
tion should  be  allowed  a  citizenship  in  France ; 
success  does  not  always  justify  rash  proceed- 
ings.'1 

"  Huguier :  '  In  spite  of  the  statistics  we  re- 
ject it  in  a  manner  almost  absolute.'2 

"  Jobert  (de  Lamballe)  :  'Extirpation  is  a 
very  dangerous  thing,  which  should  very  rarely 
be  resorted  to.'3 

"  Velpeau  :  '  The  extirpation  of  diseased  ova- 
ries is  a  frightful  operation,  which  ought  to  be 
proscribed,  though  the  cures  announced  were 
real.'4 

"  Moreau  :  '  For  myself  I  think  this  operation 
should  be  placed  among  the  prerogatives  of 
the  executioner.' s 

"  Eminent  as  all  these  speakers  were,  as 
mere  surgeons,"  Dr.  Peaslee  says,  "They  were 
scarcely  qualified  to  decide  the  question  before 
them  at  all,  and  certainly  not  without  the  most 
careful  examination. 

"  Malgaigne's  invidious  accusation  was  not 
sustained  by  the  facts  ;  while  the  conclusions  of 
Cruveilhier   were    inconsistent   with    his    own 

1  Bulletin  de  l'Academie  Imperiale,  tome  xxii.,  p.  90. 

3  Ibid.,  p.  113.  3  Ibid.,  p.  154. 

4  Ibid.,  p.  220.  5  Ibid.,  p.  226. 


j52  CRITICISMS  AND  COMMENTS. 

admissions  respecting  the  success  of  the  opera- 
tion and  the  absolute  insufficiency  of  every 
other  mode  of  treatment.  A  single  one,  how- 
ever, of  the  participants  in  that  discussion  had 
a  special  right  to  speak  with  authority  on  that 
subject.  His  special  studies  and  his  constant 
acquaintance  in  practice  with  the  nature  and 
progress  of  ovarian  tumors  qualified  him  to 
hold  an  intelligent  opinion  on  this  subject. 

"I  allude  to  the  distinguished  surgeon- 
accoucheur  Cazeaux,  whose  voice  alone  was 
raised  in  defence  of  the  operation.1  .... 

"  It  was  but  a  repetition  of  the  experience  of 
the  first  reports  of  cases  of  ovariotomy  by  Dr. 
[Ephraim]  McDowell.  When  they  reached 
Philadelphia,  Dr.  Physick,  the  great  surgeon  of 
that  time,  would  not  deign  to  notice  the  cases, 
or  justify  the  operation.  But  Dr.  James,  the 
Professor  of  Obstetrics  in  the  University  of 
Pennsylvania,  at  once  perceived  the  great 
advance  made  by  this  operation,  and  published 
the  report  in  a  journal  of  which  he  was  one  of 
the  editors.2  .... 

"  It  is,  also,  a  pertinent  fact  in  this  connection 

1  For  a  report  of  this  interesting  speech  see  Peaslee's  Ovarian 
Tumors,  p.  302 ;  also,  Monograph  on  Ovariotomy,  p.  45,  and 
loc.  cit.,  p.  181. 

J  Eclectic  Repertory,  1817. 


CRITICISMS  AND  COMMENTS. 


133 


that  not  a  single  member  of  the  Obstetrical 
Society  of  London  has  raised  an  objection  to 
the  principle  of  ovariotomy,  though  several  of 
them  were  for  years  opposed  to  it  (among 
them  Dr.  Hall  Davis,  Dr.  West,  Dr.  Savage, 
and  Dr.  W.  Tyler  Smith),  until  they  became 
acquainted  with  the  facts.1 

"  In  contrast  with  their  French  confreres,  the 
English  provincial  surgeons  early  accepted  the 
operation  of  ovariotomy,  as  we  have  seen ; 
though. those  of  the  metropolis  generally  re- 
mained indifferent,  rather  than  decidedly  op- 
posed to  it 

"  It  is  not  surprising  that  the  wholesale  de- 
nunciations of  ovariotomy,  which  I  have  quoted 
from  the  highest  and  most  influential  medical 
tribunal  in  France,  should  have  checked  its  pro- 
gress :  and  thus  we  find  that  for  the  next  five 
years,  or  up  to  the  commencement  of  1862, 
only  three  more  attempts  at  ovariotomy  were, 
made  in  that  country.  These  were  by  Hergott, 
and  Michel,  in  November,  1858  ;2  Boinet,  in 
February,  1859  ;3  and  Richard,  in  April,  1861.4 
All  of  these  were  fatal  cases 

1  Monograph,  p.  45, 

2  Gazette  Medicale  de  Strasbourg,  1859. 

3  Gazette  des  Hopitaux,  1859,  p.  571. 

4  Gazette  Hebdomadaire,  1862,  p.  531. 


!34  CRITICISMS  AND  COMMENTS. 

"In  i860  the  memoir  of  M.Jules  Worms, 
'  Sur  1' Extirpation  des  Tumeurs  cystiques 
de  l'Ovaire,'  appeared  in  the  Gazette  Hebdoma- 
daire  de  Med e cine  et  de  Chirurgie?  Being 
equally  familiar  with  the  French,  German,  and 
English  languages,  a  good  observer,  and  a 
highly  educated  physician,  M.  Worms  con- 
scientiously applied  himself  to  the  inquiry  re- 
specting the  actual  results  which  had  been 
achieved  by  ovariotomy,  especially  in  England; 
and  after  much  labor  he  arrived  at  the. conclu- 
sion that  ovariotomy  is  a  valuable  surgical  re- 
source, and  that  it  would  doubtless,  at  some 
day,  save  many  lives  in  France."  .  .  .  [See 
table  page  137.] 

In  Germany:  "Whether  the  report  of  Dr. 
Ephraim  McDowell's  first  three  cases  of  ovari- 
otomy, published  in  18 17,  as  we  have  seen,  had 
been  read  by  any  of  our  German  confreres, 
does  not  appear ;  but  it  is  certain  that,  in  less 
than  two  years  thereafter  (in  May,  18 19),  Dr. 
Chrysmar,  of  Isny,  Wiirtemburg,  performed 
this  operation  for  the  first  time,  in  Europe,2  and 

1  Pp.  642,  658,  690,  741,  and  804. 

2  The  first  three  operations  of  Dr.  Chrysmar  were  reported 
by  Dr.  Hopfer,  of  Biberbach,  in  Journal  fur  Chirurgie  und 
Augenheilkunde.  Herausgegeben  von  Dr.  Von  Grafs,  und 
Dr.  P.  F.  Von  Walther.  Zwolfter  Band  Erstes.  Heft.  pp.  60-87. 
Ibid.,  pp.  85-87. 


CRITICISMS  AND  COMMENTS.  i^ 

six  years  before  the  first  attempt  of  Mr.  Lizars. 
Dr.  Chrysmar,  also,  repeated  the  operation 
twice  more  before  the  end  of  the  year  1820. 
The  first  operation  was  unsuccessful.  The 
second  in  1820,  was  performed  in  fifteen  min- 
utes ;  the  patient  recovered,  and  two  years 
afterward  had  a  child  at  full  term.  The  third 
case  was  unsuccessful.1  .... 

"  The  operation  of  ovariotomy  was  attempted 
by  Dieffenbach,  of  Berlin,  in  1828,  but  not 
finished.2     His  patient,  however,  recovered.  .  . 

"  The  first  who  boldly  defended  ovariotomy 
in  Germany,  was  Biihring,  of  Berlin.  He  at- 
tempted to  obtain  a  footing  for  it,  as  the  only 
radical  cure  in  all  forms  of  ovarian  dropsy. 
His  monograph,  entitled,  Die  Heilung  der 
Eierstockgeschwulste,  was  published  in  1848.   .  . 

"  Dutoit3  remarks,  that  the  history  of  ovari- 
otomy in  Germany  presents  only  a  series  of 
membra  disjecta,  rendering  it  very  difficult  to 
give  an  exact  account  of  its  development  in 
that  country [See  table  page  138.] 

1  Bulletin    de  Ferussac,  tome  xviii.,  p.  86,  und  Journal  fur 
Chirurgie  und  Augenheilkunde,  B.  xii.,  p.  62. 

2  Rust's  Magazin,  B.  xxv.,  p.  349. 

3  Die  Ovariotomie  und  England,  Deutschland,  und  Frank- 
reisch,  Wurzburg,  1864,  pp.  45. 


136 


CRITICISMS  AND  COMMENTS. 


Ovariotomy  in  the  United  States. 

(From  1853  to  1864.) 


Years. 

Cases. 

Cured. 

Died. 

Years. 

Cases. 

Cured. 

Died. 

1853    •      •      • 

8 

7 

I 

1859     •      • 

7 

4 

3 

1854    .      .      . 

II 

8 

3 

i860      .      . 

3 

3 

0 

1855    •      •      ■ 

21 

6 

iS 

I86l      .      . 

3 

2 

1 

1856    .      .      . 

II 

8 

3 

1862     .      . 

4 

2 

2 

1857    ■      •      • 

5 

4 

1 

1863      .      . 

3 

2 

1 

1858    ... 

5 

3 

2 

The  total  of  the  reported  cases,  up  to  1864,  is  117;  of  which  68,  or 
58.12  per  cent,  recovered,  and  49  died. 

(From  January  1,  1864,  to  October  10,  1871.) 


Operators.1 

Cases. 

Cured. 

Died. 

Per  cent,  of 
recoveries. 

Atlee,  W.  L 

246 

172 

74 

70.00 

Kimball,  G.  (Lowell,  Mass.)  . 

121 

80 

41 

66.11 

Dunlap,  A.   (Ohio) 

60 

48 

12 

80.00 

Peaslee,  E.  R. 

28 

19 

9 

67.85 

White 

25 

17 

8 

68.00 

McRuer  (Maine)    . 

22 

16 

6 

72.72 

Thomas  ..... 

27 

18 

9 

66.66 

Bradford,  J.  P.  (Kentucky)    . 

3° 

27 

3 

90.00 

Emmet   ..... 

17 

8 

9 

47-Q5 

Sims,  J.  Marion 

12 

10 

2 

83-33 

Miner 

9 

4 

5 

44.44 

Axford 

9 

6 

3 

66.66 

Crosby    ..... 

S 

2 

3 

40.00 

Bennett,  Ezra  P.  (Connecticut) 

4 

3 

1 

75.00 

Green     ..... 

8 

5 

3 

62.50 

Tewksbury  (Portland)    . 

7 

3 

4 

42.86 

Beebe  (Chicago)     . 

6 

4 

2 

66.66 

Hill  (Augusta,  Maine)    . 

6 

3 

3 

50.00 

Noeggerath     .... 

6 

1" 

5 

16.66 

Smith,  A.  G 

5 

3 

2 

60.00 

Jackson  (Chicago) . 

4 

3 

1 

75.00 

Mussey,  R.  D.  (Cincinnati)    . 

3 

1 

2 

33-33 

Total 

660 

453 

207 

68.63 

Deduct  cases  previous  to  1864  1 

38 

included  in  above  table          J 

Total 

622 

since  J 

anuary  1, 

1864. 

The  total  reported  cases  up  to  January  1,  1864,  is 
Add  total  number  of  cases  since  January  1,  1864 


117 

622 


Total  number  of  cases  reported  up  to  October  10,  1871     739 

For  the  particulars  respecting  the  ovariotomies  reported  in  this  country, 
from  1853  to  1863  inclusive,  reference  is  made  to  the  work  of  Dutoit. 


1  For  names  and  reports  of  cases  of  ovariotomists  previous  to 
see  Dr.  Peaslee's  work,  pp.  238-267. 


CRITICISMS  AND  COMMENTS. 


137 


Ovariotomy  in  Great  Britain. 

(Up  to  January  1,  1871-72.) 


Operators. 


Wells,  T.  Spencer  . 
Clay,  Charles .... 
Keith,  Thomas  (end  of  1871 ) 
Brown,  I.  Baker  (to  1870)1  . 
Bryant,  Thomas  (to  1870)1  . 
Smith,  W.  Tyler  (to  1870)1  . 
Willett  (to  1870)1    . 


Total 


Cases. 

Cured. 

Died. 

Per  cent,  of 
recoveries. 

440 

328 

112 

74-54 

250 

182 

68 

72.80 

136 

III 

25 

81.61 

120 

84 

36 

70.00 

28 

17 

11 

60.71 

20 

16 

4 

80.00 

12 

4 

8 

33-33 

1006 

742 

264 

73-75 

Note. — As  this  table  is  made  up  of  operations  performed  by  the  most 
experienced  ovariotomists  in  Great  Britain  at  that  date  (1872),  and  does 
not  include  isolated  cases  of  other  practitioners  who  were  not  as  success- 
ful, the  percentage  of  recoveries,  of  course,  is  greater  than  if  the  table  in- 
cluded all  operations  up  to  that  date. — M.  Y.  R. 

Ovariotomy  in  France. 

(Up  to  March  31,  1867.     Made  up  from  Boinet's  Table.2) 


Operators. 


Koeberle'    . 
Boinet 

Maisonneuve     . 

Demarquay 

Nelaton 

Pean 

Richards,  A. 

Gosselin     . 

Le  Croix  (de  Beziers) 

Desgranges 

Serre  (d'Alais)  . 

Laumonier        (1781) 

Woyerkowsky  ( 1844) 

Rigaud  (I844) 

Vaullegeard      (1847) 

Other  operators  who  had  each  per- 
formed one  ovariotomy  up  to 
March  31,  1867, 

Total  in  Boinet's  table 

Other  cases  not  reported  . 

Add  cases  classed  by  Boinet  as  not  1 
published,  including  12  of  Nelaton's  j 

Rejecting,  as  we  should,  Laumonier's] 
case,  Rigaud's  case  (unfinished),  I 
Boinet's  first  case  (degenerated  j 
fibroid),  Kceberle's  case  of  uterine  [- 
fibroma,  Boinet's  case  of  uterine 
fibroid  in  1865,  and  Maisonneuve's  | 
unfinished,  J 

Total  up  to  March  31,  1867 


Cases. 


24 
7 
7 
6 

4 
4 
4 
3 
3 


95 
4 

23 


116 


Cured. 


16 

4 


Died. 


44 
o 

5 

49 


47 


17 


5i 

4 

18 


73 


65 


Per  cent,  of 
recoveries. 


66.66 
57-14 


75.00 


32.00 


40.51 


1   Grenser. 


2  Boinet's  Maladies  des  Ovaries,  1867. 


138 


CRITICISMS  AND  COMMENTS. 


Ovariotomy  in  Germany. 

(Up  to  January  i,  1870.) 

Dr.  Peaslee  states :  "  The  whole  number  of  ovariotomies  in  Germany, 
up  to  the  commencement  of  1870,  is  180,  of  which  75  resulted  in  a  cure, 
and  105  were  fatal.     The  recoveries  are,  therefore,  only  41.66  per  cent.'' 

"  Including  only  the  operations  of  the  three  most  experienced  opera- 
tors, the  following  is  the  result : 


Operators. 

Cases. 

Cured. 

Died. 

Per  ■cent,  of 
jecoveries. 

Nussbaum       .... 
Stilling    ..... 
Spiegelberg     .... 

34 
17 
14 

00  00  00 

16 

9 
6 

52-94 
47.06 

57-14 

Total 

65 

34 

3i 

52-30 

Dutoit's  Table. 

(Up  to  November  30,  1863.) 


"This  table  is  intended  to  include  all  cases  of  completed  ovariotomy  in 
the  United  States,  Great  Britain,  France  and  Germany,  up  to  November 
30,  1863.     In  all  respects  it  is  prepared  with  the  utmost  care." 


Countries. 

Cases. 

Cured. 

Died. 

Per  cent,  of 
recoveries. 

United  States  .... 
Great  Britain  .... 
France    ..... 
Germany         .... 

117 

379 

26 

55 

68 

230 

12 

15 

49 
149 

14 
40 

58.12 
60.68 
46.15 
27.27 

Total 

577 

325 

252 

56-32 

Summary   of  Cases   of   Completed   Ovariotomy   in  the 
United  States,  Great  Britain,  France,  and  Germany. 

(Up  to  1870-71.) 


Countries. 

Cases. 

Cured. 

Died. 

207 

264 

69 

I°5 

Per  cent,  of 
recoveries 

United   States  (to  1870-71), 

(739  cases  to  Oct.  10,  1871) 
Great  Britain  (to  1870-71) 
France  (to  March  31,  1867)    . 
Germany  (to  January  1,  1870) 

660 

1006 
116 

180 

453 

742 

47 
75 

68.63 

73-75 

40-51 
41.66 

Total 

1962 

I3J7 

645 

67.13 

Showing  an  increase  of  11. 13  per  cent,  of  recoveries  during  the  years 
from  November  30,  1863,  to  1871.  Since  that  date  the  percentage  of  re- 
coveries in  ovariotomy  has  been  greatly  increased,  until  now  it  is  one  of 
the  most  successful  of  difficult  surgical  operations  performed. 


CRITICISMS  AND  COMMENTS.  j  39 

Dr.  Peaslee  goes  on  to  say:  "Ovariotomy 
has  very  recently  been  performed  for  the  first 
time,  if  at  all,  in  most  of  the  countries  on  the 
Continent  which  have  not  yet  been  mentioned 
in  the  preceding  historical  sketch.  The  scattered 
facts  which  have  been  accessible  to  me  will  be 
here  stated."  .... 

In  Austria:  "Ovariotomy  had  never  been 
performed  before  1866,  and  but  twelve  times 
since.  Of  these  twelve  cases  only  one  re- 
covered  Ovariotomy    must,     however, 

soon  be  generally  accepted  in  this  country  also; 
as  the  following  extract  from  the  Surgical 
Reminiscences  of  Professor  Billroth,  of  Vienna, 
now  being  published,1  demonstrates:  'Up  to 
the  present  time,  I  am  tolerably  contented  with 

my  results Hitherto,  I  have  performed 

ovariotomy  nine  times,  and  of  these  patients 
only  two  have,  died;  giving,  therefore,  only  a 
mortality  of  22.2  per  cent.  The  first  four  cases 
recovered,  one  after  another,  then  the  fatal  cases 
occurred;  to  be  followed  again  by  three  recov- 
eries. The  first  case  is  related  in  my  Zurich 
Chirurgische  Klinik,  and  the  second,  third,  and 
fourth  cases  in  the  Chirurgische  Klinik,  pub- 
lished at  Vienna,  in  1868.'"  .  .  .  . 

1  In  the  Wiener  med.  Wochenschrift,  1871. 


140 


CRITICISMS  AND  COMMENTS. 


In  Spain:  "  Ovariotomy  was  first  performed 
in  this  country,  and  unsuccessfully,  by  Dr.  F. 
Rubio,  of  Seville.1" 

In  Italy:  "It  is  asserted  by  Fehr,2  that  the 
first  operation  of  ovariotomy,  in  Europe,  was 
performed  by  an  Italian  physician,  Dr.  Emiliani, 
of  Faenza,  in  1815,  this  being  four  years  in  ad- 
vance of  the  operation  by  Chrysmar,  of  Isny." 

In  Sweden  ;  "Two  successful  operations  were 
performed  by  Mesterton,  at  Upsala,  in  1862." 

In  Finland:  "Haartman,  of  Helsingfors,  ope- 
rated in  February,  1849.  The  patient  died  in 
two  days,  of  peritonitis." 

In  Poland:  "In  i860,  Bryk  operated  in  Cra- 
cow ;  the  patient  dying  four  days  afterward." 

In  Switzerland:  "Breslau,  of  Zurich,  operated 
unsuccessfully,  in  October,  1862,  and  afterward 
three  times  successfully.  Dr.  Montel,  of  Vevay, 
had  a  successful  operation  in  1865.  It  was  a 
case  of  large  polycyst."3 

In  Belgium:  "Dr.  Boddaut  was  the  first 
Belgian  surgeon  who  successfully  practised 
ovariotomy." 

In  Russia:  "Ovariotomy  was  first  successfully 

1  The  Lancet,  1863,  vol.  ii.,  p.  636. 

2  Die  Ovariotomie,  p.  6. 

3  Gazette  Hebdomadaire,  March  7,  1865. 


CRITICISMS  AND  COMMENTS.  l*l 

performed  in  Russia,  December  23,  1862,  by 
Dr.  A.  Krassovsky,  at  St.  Petersburg."1 

In  India :  "  Ovariotomy  was  twice  successfully 
performed  by  Dr.  J.  M.  Joseph,  surgeon  of  the 
Civil  Hospital,  Combaconum.2  In  1869,  it  had 
been  performed  three  times  by  a  native  surgeon, 
Dr.  Mootoosawny  Moodelly,  of  Manargudi, 
Tanjore  District."3  .... 

In  Ceylon :  "  Ovariotomy  has  been  performed 
by  Dr.  P.  D.  Anthonisy."4 

In  New  Zealand:  "Ovariotomy  has  been 
successfully  performed  by  Dr.  R.  Tassel,  of 
Auckland."5 

In  Australia:  "Dr.  Tracy,  of  Melbourne, 
was  the  first  to  perform  ovariotomy,  and  he 
saved  ten  out  of  his  first  thirteen  patients."6 

NOTE. — The  limits  of  this  work  will  not  admit  of  our  including  in  the 
foregoing  article  the  records  of  many  distinguished  ovariotomists,  as  our 
design  is  simply  to  give  a  brief  sketch  of  ovariotomy  in  its  infancy,  but 
we  refer  the  reader  to  the  statistics  which  will  be  found  in  the  valuable 
treatise  from  which  these  excerpts  and  tables  are  mostly  taken,  and,  also, 
to  other  articles  in  this  book. — M.  Y.  R. 

1  Petersburger  Medicin  Zeitschrift,  1863. 

2  Indian  Annals  of  Medical  Science,  January,  1858. 

3  Reported  in  the  Obstetrical  Trans.,  1869,  vol.  x.,  p.  119. 

4  The  Lancet,  1864,  vol.  ii.,  p.  728. 

5  Ibid.,  1870,  vol.  ii.,  p.  507. 

6  Ibid.,  187 1,  vol.  ii.,  p.  517. 


CHAPTER    IX. 

COMMENTS    UPON    OVARIOTOMY. 

Dr.  Washington  L.  Atlee,  in  his  valuable 
work  entitled  Diagnosis  of  Ovarian  Tumors, 
writes  as  follows  :  "A  patient  seldom  has  any 
direct  evidence  of  the  existence  of  an  ovarian 
tumor  until  she  can  feel  it  above  the  brim  of 
the  pelvis,  or  until  some  enlargement  of  the 
abdomen  has  occurred  ;  and  as  she  does  not 
usually  seek  the  opinion  of  a  surgeon  before 
one  or  the  other  takes  place,  I  shall  confine  my 
remarks  on  diagnosis  to  tumors  after  they  have 
invaded  the  cavity  of  the  abdomen.  This  is 
especially  appropriate,  as  the  subject  will  be 
discussed  in  reference  to  the  question  of  ova- 
riotomy— an  operation  unlikely  to  be  performed 
before  the  tumor  has  been  elevated  above  the 
brim  of  the  pelvis."  He  cites  an  interesting 
case  (XIV.)  entitled  as  follows:  "An  ovarian 
cyst  tapped  twice  ;  subsequently  a  communication 
established  with  the  bowel,  by  means  of  which  the 
contents  of  the  cyst  were  evacuated  and  flatus 

entered  the  cyst '." 
(142)  ' 


COMMENTS  UPON  OVARIOTOMY.  j^ 

"On  September  i,  1869,  I  visited  Princeton, 
New  Jersey,  for  the  purpose  of  operating  on 
Miss  E.  B.  R.,  daughter  of  a  clergyman  of  that 
city,  and  a  patient  of  Dr.  J.  A.  Wikoff. 

"  In  his  letter  requesting  my  attendance,  Dr. 
Wikoff  wrote :  '  She  is  a  young  lady  of  about 
twenty-five,  has  recently  come  under  my  care, 
and  is  suffering  from  an  ovarian  tumor. 
Three  years  ago  she  was  living  near  New 
York,  and  was  under  the  care  of  Drs.  Dela- 
field  and  Markoe,  who  twice  tapped  her  pre- 
paratory to  ovariotomy.  Her  health,  however, 
failing,  they  deemed  it  prudent  not  to  operate ; 
but  just  as  they  imagined  she  was  about  to 
die,  nature  interfered  and  relieved  her  in  a 
most  remarkable  way.  To  within  a  few  months 
she  has  been  in  comparatively  good  health, 
but  now  the  tumor,  which,  I  think,  is  composite 
in  its  nature,  is  increasing  and  her  health  is 
suffering.' 

"The  following  intelligent  history  of  the  case 
was  written  by  the  father  of  the  lady:  'The 
first  symptoms  of  this  disease  were  noticed  by 
her  mother  and  herself  in  April,  1865,  there 
being  a  hardness  of  the  bowels,  attributed  by 
them  to  dyspepsia,  which  was  accompanied  by 
paleness  and  want  of  appetite. 


!44  COMMENTS  UPON  OVARIOTOMY. 

"  'She  paid  a  visit  of  six  weeks  at  this  time  to 
some  friends  in  Camden  and  Philadelphia,  and 
when  she  returned  in  June  there  was  a  mani- 
fest enlargement  of  the  stomach  and  waist, 
which  alarmed  us,'  when  we  called  a  physician, 
who  pronounced  it  dropsy  and  gave,  without 
benefit,  the  ordinary  remedies  for  that  disease. 
Her  strength  being  reduced  (under  the  treat- 
ment for  two  weeks)  very  much,  and  violent 
pains  increasing,  we  took  her  to  New  York, 
and  placed  her  under  the  care  of  Drs.  Dela- 
field  and  Markoe,  who,  after  treatment  of  a 
week,  pronounced  it  ovarian  dropsy.  They 
then  prescribed  iron,  with  careful  diet  and  ex- 
ercise, and  a  return  to  the  country.  In  Sep- 
tember, iodine  was  substituted  for  iron,  together 
with  palliatives. 

"  'She  continued  to  increase  in  size  through 
the  winter,  until  she  was  enormously  swollen, 
the  fluid  rising  very  high,  even  displacing  the 
heart,  so  that  it  seemed  to  beat  under  the 
shoulder. 

"  'Her  flesh  had  been  very  much  reduced,  yet 
she  was  strong  enough  to  go  up  and  down  the 
stairs  and  ride  out,  although  very  heavy  upon 
her  feet.  She  ate  moderately  of  anything  she 
fancied  with  tolerable  comfort. 


COMMENTS  UPON  OVARIOTOMY. 


145 


"  'In  February,  1866,  she  was  taken  to  New 
York  to  be  tapped,  not  suffering  from  the  trip. 
My  wife  says  that  more  than  two  pails  of  fluid, 
or  fifty-two  pounds,  were  evacuated,  of  the 
appearance  and  consistency  of  stale  lees  or 
porter  (perhaps  a  little  thicker).  She  was  very 
weak  after  tapping,  but  soon  rallied,  and  in  a 
little  more  than  a  week  was  walking  about  the 
house,  and  then  visited  with  comfort  some 
friends  in  the  city.  She  soon  began  to  fill 
again,  although  it  did  not  show  for  a  month. 

"  'She  regained  strength  and  flesh  rapidly, 
and  seemed  well  notwithstanding  the  gradual 
increase  in  size  until  July,  when  her  health  be- 
gan to  suffer. 

"  'In  the  latter  part  of  August  there  seemed  to 
be  a  regular  recurrence  of  fever  at  night,  which 
Dr.  M.  thought  to  be  independent  of  the  dis- 
ease, and  for  which  he  prescribed  (although  he 
did  not  see  her)  without  effect.  During  the 
intense  heat  of  that  season,  nervous  symptoms 
of  an  alarming  character  set  in  with  the  nightly 
fever. 

"'On  Friday  night  they  intensified,  and  the 
next  day  continued  so  that  the  family  physician 
said  that  her  brain  was  affected. 

"  'Saturday  night  she  had  a  spasm,  accompa- 


Iz,6  COMMENTS  UPON  OVARIOTOMY. 

nied  and  followed  by  violent  demonstrations, 
screaming,  gritting  the  teeth,  and  terror,  like 
delirium  tremens. 

"'Between  two  o'clock,  a.m.,  Saturday,  and 
two  o'clock,  p.m.,  Sunday,  she  had  six  spasms. 
At  the  latter  hour  (Dr.  Markoe  arriving  from 
Long  Branch)  she  was  persuaded  to  be  tapped, 
and  remained  calm  during  the  operation,  about 
three-quarters  of  an  hour. 

" '  Three-fourths  of  a  pailful  of  gelatinous  fluid 
was  drawn  away,  with  sensible  relief,  although 
the  excitement  (which  Dr.  Markoe  pronounced 
hysterics)  subsided  but  little.  She  seemed 
strong,  and  could  not  be  kept  quiet  through 
the  night,  but  the  next  morning  was  very  much 
exhausted,  so  that  we  used  brandy  and  hot 
bricks  at  the  feet  to  restore  her. 

"'She  gradually,  however,  increased  in 
strength  and  grew  a  little  more  calm  after  a 
week,  but  was  far  from  being  like  herself. 

"'It  was  evident  that  she  was  slowly  filling 
again,  but  her  habits  were  so  whimsical  and 
secretive  that  we  could  not  inform  ourselves 
particularly. 

"  '  During  this  time  she  went  up  and  down  in 
the  house  and  out  of  doors  as  she  pleased,  but 
would  not  see  any  one,  even  the  members  of 


COMMENTS  UPON  OVARIOTOMY.  Izj^ 

the  family  more  than  could  be  avoided  ;  went 
to  the  table  after  meals,  and  helped  herself,  as 
she  would  not  be  waited  on. 

"  'About  the  last  of  September,  1866,  we  no- 
ticed a  manifest  diminution,  accompanied  by 
violent  diarrhoea,  for  two  weeks  or  more,  end- 
ing- in  entire  relief,  both  of  body  and  mind,  as 
she  became  cairn  and  natural  just  in  propor- 
tion as  the  fluid  passed  away. 

"  'In  two  or  three  weeks  she  had  regained 
both  strength  and  flesh,  and  seemed  like  herself. 
She  spent  several  weeks  in  Camden  and  Phila- 
delphia, enjoying  herself,  during  this  winter  as 
much  as  ever  before. 

"  '  In  the  summer  of  1867  she  noticed  a  lump 
as  large  as  a  walnut  (she  thinks  on  the  right 
side),  which  gradually  increased  during  the 
summer  to  the  size  of  an  orange,  and  in  the 
fall  seemed  to  flatten  and  slowly  to  spread 
laterally.  But  from  the  time  she  noticed  it 
first,  in  1867,  until  in  1868,  it  seemed  to  be 
hard  over  the  stomach.  She  could  push  it  with 
ease  (as  she  expressed  it)  from  one  side  of  the 
stomach  to  the  other,  and,  after  it  became  larger, 
could  lift  up  the  sides  of  it  with  her  hands  under 
the  skin.  September,  1868,  she  noticed  a  ten- 
dency to  increase,   but  it  gave  her   no  incon- 


I48  COMMENTS  UPON  OVARIOTOMY. 

venience  until  within  two  months,  when  Dr. 
Wikoff  became  cognizant  of  the.  case,  to  whom 
I  refer  you  for  further  details.' 

"Two  or  three  days  before  visiting  the  pa- 
tient for  the  purpose  of  performing  ovariotomy, 
she  was  taken  suddenly  with  diarrhoea,  accom- 
panied with  copious,  watery  and  dark-colored 
discharges,  affording  her  considerable  relief, 
and  causing  some  subsidence  of  the  abdominal 
enlargement.  Still  she  was  as  large  as  a 
woman  at  full  period  of  gestation. 

'■  When  lying  on  her  back  the  percussion 
sound  was  resonant  over  the  whole  abdomen 
in  front,  and  dull  below  and  along  the  sides, 
just  as  is  found  in  ascites. 

"In  an  upright  position,  resonance  existed 
over  the  epigastrium  ;  and  when  lying  on 
either  side  it  was  noticed  in  the  opposite  side. 
A  large  cyst,  with  multilocular  deposits  in  its 
walls,  could  be  detected,  occupying  the  whole 
cavity  of  the  abdomen,  containing  both  liquid 
and  air — some  of  the  liquid,  no  doubt,  having 
escaped  into  the  bowel,  and  flatus  from  the 
canal  having  found  its  way  into  the  cyst.  This 
was  made  still  more  evident  by  succussion. 

"  The  body  of  the  uterus  was  wholly  buried  in 
a  mass  occupying  the  superior  strait  of  the  pel- 


COMMENTS  UPON  OVARIOTOMY.  149 

vis,  and  was  immovable.  The  os  tincae  could 
scarcely  be  detected  on  the  left  side  of  the 
pelvis.  The  sound  entered  the  uterus  two 
inches. 

"Under  these  circumstances  I  declined  to 
operate,  as  the  opening-  in  the  bowel  was  calcu- 
lated to  cause  a  fatal  result.  Besides,  nature 
itself  was  making  an  attempt  to  relieve  the 
patient. 

*'  September  30,  1869,  Dr.  W.  wrote:  '  Miss 
R.  is  gradually  improving.  The  cyst  has  com- 
pletely emptied  itself,  and  she  is  no  larger  than 
natural.  The  discharges  kept  up  for  about 
three  weeks  from  twenty-four  to  ten  a  day.' ' 

Nature  in  this  peculiar  case  was  the  success- 
ful physician. 

"  Percussion  and  palpation  become  very  im- 
portant aids  in  detecting  the  existence  and 
location  of  ovarian  and  other  abdominal  tumors. 
A  patient  should  be  examined  with  the  abdo- 
men uncovered,  and  first  in  the  sitting  posture. 
The  whole  surface  of  the  region  should  then  be 
explored  by  palpation,  varying  the  pressure. 

"By  this  means  we  are  all  able,  through  the 
sense  of  touch  alone,  to  detect  the  presence  of 
peritoneal  fluid  between  the  surface  of  the 
tumor  and  the  walls  of  the  abdomen  ;  to  decide 


15o  COMMENTS  UPON  OVARIOTOMY. 

on  the  character  of  the  tumor  ;  to  detect  the 
existence  of  smaller  bodies  in  the  walls  of  a 
large  cyst,  and  frequently  to  trace  the  outlines 
of  several  cysts,  by  the  sulci  which  divides  a 
polycystic  mass.  During  this  examination  the 
eye  of  the  surgeon  should  follow  all  the 
motions  pf  the  hand — the  general  contour  of 
the  abdomen,  as  well  as  the  form  of  the  several 
parts,  being  worthy  of  the  closest  observation. 

'•'  Different  inferences  would  be  drawn  ac- 
cording to  the  impression  imparted  to  the  hand 
and  the  shape  of  the  abdomen. 

"  The  patient  being  still  in  a  sitting  posture, 
percussion  should  next  be  practised  by  placing 
the  palmar  surface  of  the  finger  of  one  hand 
upon  the  abdomen  and  striking  it  with  the  ends 
of  the  fingers  of  the  other  hand,  and  noticing 
closely  the  sounds  elicited. 

"  It  is  well  known  that  when  percussion  is 
made  over  any  part  containing  air  there  will  be 
a  reverberation  of  sound,  which  is  denominated 
resoiiance,  while  over  a  liquid  or  a  solid  a  flat 
or  dull  sound  is  returned.  Therefore  an  ova- 
rian or  other  solid  tumor,  located  anterior  to 
the  viscera,  must  give  off  a  dull  percussion 
sound  over  the  anterior  part  of  the  abdomen, 
and  indeed  over  the  whole  space  occupied  by 


COMMENTS  UPON  OVARIOTOMY.  I^I 

it;  whereas  the  intestines,  which  always  con- 
tain more  or  less  air,  must  return  a  resonant 
percussion  sound,  and  are  usually  thus  traced, 
occupying  the  lumbar,  hypochondriac,  and  epi- 
gastric regions,  being  crowded  beyond  the 
borders  of  the  tumor.  A  patient,  therefore, 
having  an  ovarian  tumor  filling  the  abdominal 
cavity  and  crowding  closely  upon  the  viscera, 
will  almost  universally  be  free  from  a  resonant 
percussion  sound  over  every  part  of  the  abdo- 
men except  in  the  regions  above  stated,  and 
not  unfrequently  this  sound  is  absent  in  one  or 
more  of  these  localities." 

In  illustrating  a  peculiar  condition  to  which 
Dr.  Atlee  was  anxious  to  call  the  attention  of 
the  profession,  viz.,  the  character  of  the  fluid 
removed  by  tapping,  and  the  value  of  this  opera- 
tion as  a  means  of  diagnosis,  he  writes  as  fol- 
lows : 

"We  have  seen  that  even  Mr.  Spencer 
Wells,  whom  we  all  delipfht  to  honor  as  the 
highest  authority  in  ovariotomy,  was  corrected 
in  his  diagnosis  of  a  case  only  by  the  charac- 
ter of  the  fluid,  so  exactly  did  it  resemble,  in 
every  feature,  an  ovarian  tumor.  This  circum- 
stance, instead  of  disparaging  our  great  master 
in  England,  adds  to  his  character,  by  proving 


It2 


COMMENTS  UPON  OVARIOTOMY. 


how  closely  observant  he  is  of  every  phase  of 
differential  diagnosis,  and  should  warn  others, 
of  less  experience,  not  to  be  too  sanguine  in 
expressing  an  opinion  until  they  have  adopted 
every  possible  means  of  examination." 

Dr.  Edmund  Randolph  Peaslee,  in  his  work 
on  Ovarian  Tumors,  published  in  1S72,  sets 
forth  the  facts  establishing  the  claim  of  Dr. 
Ephraim  McDowell  to  priority  as  an  ovarioto- 
mist,  and  gives  a  history  of  the  four  cases  of 
Mr.  Lizars,  from  which  the  following  excerpts 
are  taken  : 

"From  1786,  when  John  Hunter  published 
an  opinion  I  have  already  quoted  (p.  235),  that 
hydatid  ovarian  cysts  may  be  extirpated  when 
they  first  begin  to  grow,  I  do  not  find  the  extir- 
pation of  ovarian  tumors  considered  by  any 
writer  in  Great  Britain  till  the  year  1824.  Dr. 
McDowell's  report  of  his  first  three  cases,  in- 
tended for  Mr.  Bell,  had  slumbered  in  Mr. 
Lizars's  possession  for  more  than  seven  years, 
and  was  now  to  see  the  light.  While  I  do  not 
explain  the  former  fact,  Mr.  Lizars  had  himself 
now  to  publish  a  case  of  attempted  ovariotomy, 
and  Dr.  McDowell's  report  was  appended. 

"The  patient  had  been  believed  by  Mr. 
Lizars,  and  'all  other  eminent  surgeons  who  had 


COMMENTS  UPON  OVARIOTOMY.  ^3 

seen  the  case,'  to  have  had  an  ovarian  cyst.  She 
had  been  tapped,  though  it  is  not  stated  whether 
any  fluid  was  obtained.  Making  an  incision 
'parallel  with  and  to  the  left  side  of  the  linea 
alba  about  two  inches  from  the  ensiform  carti- 
lage to  the  crista  of  the  os  pubis,'  he  found  no 
tumor  at  all ;  that  both  ovaries  were  healthy ; 
and  that  the  supposed  ovarian  tumor  was 
merely  an  accumulation  of  fat  under  the  skin  of 
the  abdomen,  and  of  gas  in  the  intestines.  In 
such  circumstances,  Dr.  McDowell's  report  of 
three  cases  afforded  a  precedent  for  his  opera- 
tion, if  it  did  not  indorse  his  diagnosis 

"The  next  year,  1825,  Mr.  Lizars  attempted 
ovariotomy  three  times  in  three  successive 
months,  February  27th,  March  2  2d,  and  April 
24th.  The  results,  however,  were  not  flattering. 
All  three  were  believed  to  be  cases  of  ovarian 
tumor,  at  the  time  of  the  operations ;  but  two 
of  the  tumors  were  not  removed  on  account 
of  adhesions 

"Mr.  Liston  remarks  of  Mr.  Lizars's  first  case, 
that  he  had  himself  treated  this  patient  for 
lumbar  abscess  with  disease  of  the  spine.  She 
recovered  from  the  former,  but  the  bones  had 
grown  together,  and  her  stature  had  much 
diminished.     She  was  now  a  puffy,  podgy,  little 


ICA  COMMENTS  UPON  OVARIOTOMY. 

■woman,  with  an  exceedingly  prominent  belly. 
She  begged  Mr.  Liston  to  perform  the  opera- 
tion, but  he  endeavored  to  persuade  her  not  to 
submit  to  it.  Alluding-  to  Mr.  Lizars's  other 
operations  in  private  practice,  he  adds,  as  if  he 
had  assumed  the  control  of  both  the  operator 
and  the  operation,  'For  I  took  care  to  prevent 
him  from  cutting  open  women's  bellies  in  the 
hospital  after  he  became  attached  to  it.'"1 

Prof.W.  Gill  Wylie,  of  New  York,  reports  one 
hundred  and  ten  laparotomies — sixty-one  con- 
secutive operations  without  a  death.2  He  very 
judiciously  says:  "A  number  of  cases  were 
sent  to  me  for  operation  where  the  patients  gave 
all  the  subjective  symptoms  of  serious  func- 
tional disturbance,  if  not  of  actual  disease  of 
the  appendages  ;  but,  on  account  of  absence 
of  any  positive  objective  signs  of  actual  enlarge- 
ment or  disease,  I  refused  to  operate.  There 
certainly  are  a  number  of  cases  where  both 
local  and  general  treatment  fails  to  give  relief 
from  pain,  and  where  complete  loss  of  health 
is  due,  apparently,  to  disease  or  to  a  faulty 
action  of  the  generative  organs,  and  where,  on 
examination,  all  we  can  find  is  an  imperfectly 
developed,  anteflexed  uterus  with  a  prolapsed 

1  The  Lancet,  February  8,  1845. 

3  Annals  of  Gynecology,  December,  1887. 


COMMENTS  UPON  OVARIOTOMY.  155 

left  ovary  and  a  general  condition  of  hyperes- 
thesia on  both  sides.  The  question  is,  in  such 
cases,  when  all  other  means  fail  to  give  relief, 
are  we  justified  in  removing  the  tubes  and 
ovaries  to  put  a  stop  to  functional  activity? 
Next,  does  the  operation  really  cure  such 
cases  ?" 

Taking  a  view  of  laparotomy  on  the  other 
side,  are  all  the  unsuccessful  cases  truthfully 
reported?  And  is  an  estimate  of  the  deaths 
caused  from  the  operation  announced? 

Surgery  has  its  fashions  in  laparotomy,  and 
when  such  is  the  case  the  operation  is  likely  to 
be  carried  to  excess,  and  the  rash  and  incom- 
petent make  mistakes,  causing  condemnation 
to  rest  upon  what  is  good. 

Dr.  Augustin  H.  Goelet,  of  New  York,  who 
is  strongly  in  favor  of  electricity  as  a  substitute 
for  laparotomy,  and  who  advances  some  good 
ideas,  says : 

"When  we  take  into  consideration  the  risk 
involved,  coupled  with  the  fact  that  the  ulti- 
mate result  is  not  always  what  is  desired, 
laparotomy  can  by  no  means  be  considered 
successful  or  satisfactory  when  done  for  the 
uterine  appendages.  Unless  it  affords  positive 
relief  of  the  symptoms  which  caused  the  pres- 


!  £  6  COMMENTS  UPON  O  VARIO  TO  MY. 

ence  of  the  disease  to  be  detected,  it  cannot 
be  considered  even  a  justifiable  operation.  If 
pain,  the  main  symptom  which  drove  the  pa- 
tient to  seek  relief,  persists  after  the  opera- 
tion, what  has  been  gained  beyond  permanent 
sterility  ? 

"The  recovery  of  the  patient  from  a  danger- 
ous operation  often  serves  to  eclipse  the  purpose 
for  which  it  was  intended,  and  is  mistaken  for 
success,  adding  to  the  record  of  the  successful 
operator,  but  in  no  way  benefiting  the  patient. 
The  mental  impression  produced  upon  her  may 
serve  to  satisfy  her  for  a  time,  until,  when  this 
subsides,  she  awakens  to  the  truth  that  she  is 
no  better  than  before. 

"The  proof  of  this  assertion  is  to  be  found 
in  the  fact  that  a  successful  laparotomist  has 
published  an  elaborate  paper  upon  the  cause 
of  pain  following  laparotomy.  Also  in  substan- 
tiation is  the  fact  that  operators  declare  that 
temporary  improvement  frequently  follows 
laparotomy  when  the  abdomen  is  only  opened, 
inspected,  and  immediately  closed,  the  condi- 
tion found  being  unfavorable. 

"The  patient  is  often  so  overwhelmed  by  the 
magnitude  of  the  disclosure,  as  well  as  by  the 
long  list  of  successful  operations  of  the  man 


COMMENTS  UPON  OVARIOTOMY. 


157 


who  advises  her,  that  she  does  not  think  to 
question  the  ultimate  results  of  these  perform- 
ances, but  consents  with  a  sort  of  resignation 
to  a  fate  from  which  she  is  given  no  choice. 
Nothing  else  having  been  suggested  by  her 
adviser,  she  argues  that  there  is  no  alternative, 
for  the  principle  of  the  laparotomist  is,  '  If  an 
eye  offend  thee,  pluck  it  out.'  If  the  tubes  and 
ovaries  are  diseased,  take  them  away.  Do  not 
try  to  cure  them.     Get  clear  of  them. 

"  It  has  been  said,  and  with  some  degree  of 
truth,  that  there  are  more  healthy  ovaries  re- 
moved than  diseased  ones.  Hence  the  term 
normal  ovariotomy,  which  is  a  blot  upon  the 
escutcheon  of  the  profession. 

"We  might  enumerate  many  surgeons  who 
are  opposed  to  promiscuous  laparotomy  and 
strongly  in  favor  of  ovariotomy — the  latter 
the  only  remedy  for  ovarian  tumor;  but  we 
have  not  space  to  devote  to  this  very  interest- 
ing subject." 


CHAPTER   X. 

JOSEPH    NASHE    McDOWELL,  M.D. 

As  we  have  referred  to  several  of  the  rela- 
tives of  Dr.  Ephraim  McDowell  in  this  work, 
we  are  not  to  lose  sight  of  his  nephew,  Dr. 
Joseph  Nashe  McDowell,  whose  eminence  as  a 
surgeon  and  a  man  of  brilliant  intellect  was 
acknowledged  throughout  the  southern  and 
western  countries. 

He  founded  the  "McDowell  Medical  Col- 
lege" in  St.  Louis,  and  that  city  owes  to  him 
the  establishment  of  its  most  thorough  and 
prosperous  medical  school. 

A  few  years  after  the  death  of  its  founder, 
for  some  reason  unknown  to  the  writer,  St. 
Louis,  the  city  of  his  adoption,  changed  the 
name  of  the  "McDowell  Medical  College"  to 
that  of  the  "Missouri  Medical  College,"  which 
name  it  bears  at  the  present  time. 

The  college  is  in  a  prosperous  condition,  and 

the  faculty  is  composed  of  the  most  prominent 

physicians  of   the    city.      Many  students   from 
(158) 


JOSEPH  NASHE  MCD O  WELL.  1 5  g 

the  South  patronize  the  school,  there  being 
usually  about  three  hundred  in  attendance. 

Although  Dr.  J.  Nashe  McDowell  was  born 
and  reared  in  Lexington,  Kentucky,  his  inte- 
rests and  local  attachments  were  closely  iden- 
tified with  those  of  St.  Louis,  Mo. 

He  had  many  enthusiastic  friends  there  and 
in  the  South,  who  warmly  espoused  his  cause, 
and  the  medical  profession  in  St.  Louis  recog- 
nized that  fact. 

Col.  Thomas  Marshall  Green,  an  exceedingly 
gifted  and  fluent  writer,  speaks  of  him  in  the 
following  language  :  "It  was  not  solely  as  a 
lecturer  in  medicine  and  surgery  that  the  ora- 
torical gifts  of  Dr.  Joseph  Nashe  McDowell 
shone  conspicuously  ;  of  varied  and  extensive 
culture,  his  gifts  made  him  the  delight  of  lite- 
rary circles,  and  the  West  contained  no  more 
eloquent  speaker  on  political  topics  than  was 
this  able  and  learned  teacher  of  the  healing 
art. 

"He  abandoned  the  rigid  Calvinism  of  the 
McDowell  without  adopting  the  gentler  tenets 
of  Arminianism;  discarding  their  Federalism, 
his  devotion  to  the  'lost  cause'  made  him  an 
exile  from  his  home  and  country. 

"  Thus  died  a  man  whose  learning,  genius, 


l60  JOSEPH  NASHE  MCDOWELL. 

and  enthusiasm,  had  his  life  been  guided  by  the 
principles  and  religion  of  his  fathers,  would 
have  placed  him  at  the  very  head  of  his  profes- 
sion, and  have  made  him  eminent  in  any  walk 
of  life  and  in  any  country."  Col.  Green  con- 
tinues: "From  Dr.  Samuel  Gross,  with  whom 
he  frequently  came  in  angry  collision,  his 
genius  and  superior  talents  extorted  the  admis- 
sion that  Dr.  McDowell  was  an  eloquent  and 
enthusiastic  teacher  of  anatomy,  who  had  a  re- 
markable gift  of  speech,  and  who  could  enter- 
tain and  amuse  a  class  in  a  wonderful  way." 

In  a  recent  conversation  with  Dr.  John  H. 
Tate,  of  Cincinnati,  Ohio,  that  gentleman  re- 
marked "  that  he  considered  Dr.  Joseph  Nashe 
McDowell  the  finest  demonstrator  of  anatomy 
in  the  whole  country." 

In  1838  he  delivered  so  able  a  lecture  before 
the  students  in  the  Ohio  Medical  College  as  to 
give  him  great  celebrity  as  a  lecturer  and 
teacher.  As  a  surgeon  he  performed  more 
general  operations,  and  amputated  more  arms 
and  legs  than  any  practitioner  in  the  city  of  St. 
Louis. 

He  was  a  very  profane  man,  using  oaths 
freely.  On  an  occasion  he  was  hurriedly  called 
in    to    amputate  the  limb    of  a  poor  unfortu- 


JOSEPH  NASHE  MCD  O  WELL.  1  ft  l 

nate  laboring  man,  who  had  accidentally  had 
his  leg  terribly  crushed  in  some  machinery  con- 
nected with  a  saw  mill.  Dr.  McDowell  went 
as  soon  as  possible  to  the  relief  of  the  sufferer, 
and  as  he  entered  the  threshold  of  the  door  com- 
menced swearing  at  a  dreadful  rate,  saying, 
"  Where  is  the  d — n  rascal  ?  I  have  come  to 
cut  him  to  pieces,  d — n  his  trifling  soul !  Why 
did  he  not  keep  away  from  the  d — d  machinery? 
and  other  such  vituperative  expressions  con- 
tinued to  pour  from  his  lips  until  he  reached 
the  bedside  of  his  patient. 

He  turned  to  the  man,  who  was  writhing  in 
agony,  and  said :  "  Sir,  I  have  come  to  cut  you 
up,  d — n  you  !  The  instruments  are  all  ready," 
displaying,  with  the  remark,  the  glistening 
instruments  that  were  to  do  the  work. 

The  poor  sufferer,  paralyzed  and  dazed,  real- 
ized how  completely  he  was  in  the  power  of  the 
Doctor. 

"  Now,  sir,  hold  still  and  I  will  make  quick 
work  of  it ; "  and  in  a  very  short  time  the  Doctor 
amputated  the  limb,  dressed  the  wound,  and 
had  the  man  made  as  comfortable  as  possible. 

When  the  operation  was  over  he  asked  the 
patient  how  he  felt.  The  man  replied,  "  Doctor, 
you  frightened  me  so  badly  I  did  not  feel  you 


l62  JOSEPH  NASHE  MCDOWELL. 

cut  my  leg  off."  The  Doctor  then  explained  to 
him  that  he  had  taken  this  mode  to  lessen  his 
pain,  adding,  "  My  poor  unfortunate,  I  felt  all 
your  pain  for  you." 

The  man  soon  recovered ;  and  frequently 
expatiated  on  his  operation,  telling  his  friends 
how  Dr.  McDowell  had  cut  his  leg  off,  and  what 
a  great  man  he  was. 

o 

Apparently  the  brusque,  off-handed  manner 
of  the  Doctor  caused  many  persons  to  judge 
him  wrongfully,  and  to  believe  him  void  of  that 
tender  sympathy  which  it  is  so  necessary  for  a 
physician  to  possess.  Such  was  not  the  case  ; 
on  the  contrary,  a  warm  and  generous  heart 
beat  within  his  bosom,  and  he  was  unusually 
kind  and  considerate  with  the  poor.  Much  of 
his  practice  was  gratuitous. 

His  appearance  attracted  general  attention. 
He  was  above  the  medium  height,  and  from  his 
boyhood  had  been  remarkably  thin  and  angular, 
having  sharp-cut  features  and  small,  penetrating 
eyes  that  seemed  to  look  into  the  very  recesses 
of  one's  .soul.  This  emaciated  appearance 
suggested  to  the  medical  students  the  pseudo- 
nym of  "  Sawbones,"  a  name  he  was  well  known 
by,  not  only  among  the  young  men  but  among 
his  friends. 


JOSEPH  NASHE  MCDOWELL.  ^3 

When  he  was  a  youth  much  of  his  time  was 
spent  in  the  family  of  his  uncle,  Dr.  Ephraim 
McDowell,  and  it  was  there  that  he  formed 
an  ardent  attachment  for  his  cousin,  Mary 
McDowell,  whose  beauty  has  been  alluded  to. 

When  he  made  his  vows  expressing  more, 
than  coitsinly  affection  for  her,  she,  with  a  sin- 
cerity and  frankness  that  characterize  a  genuine 
noble-hearted  girl,  candidly  told  him  that  she 
could  only  regard  him  in  the  light  of  a  relative, 
never  in  that  of  love,  desiring  him  earnestly  to 
banish  from  his  mind  such  a  thought  as  making 
her  his  wife. 

She  confided  to  her  father,  as  became  a 
daughter,  what  she  had  heard  from  her  cousin. 
Dr.  McDowell  immediately  sought  his  nephew, 
and  with  kind,  but  decisive,  manner  empha- 
sized her  decision  and  request.  The  nephew 
became  angry  and  reflected  on  his  uncle, 
charging  him  with  influencing  his  daughter 
against  him,  an  inference  in  which  he  un- 
doubtedly was  mistaken. 

From  that  time  a  coolness  existed  between 
the  two,  the  nephew  leaving  his  uncle's  house 
and  never  returning-,  nor  did  he  ever  forgive 
him.  He  sought  new  fields  of  friendship,  and 
in  course  of  time  a  new  field  of  love. 


1 64  JOSEPH  NASHE  MCDOWELL. 

The  two  never  met  again.  The  younger 
carried  with  him  to  the  grave  his  feeling  of 
hatred  toward  the  elder,  and  never  would  listen 
to  any  eulogy  bestowed  on  him  for  his  grand 
surgical  achievements.  Shortly  after  this  occur- 
rence he  removed  to  Cincinnati,  Ohio,  and 
commenced  the  practice  of  medicine. 

Surgery  was  his  specialty.  He  was  con- 
sidered a  bold  operator.  Dr.  Daniel  Drake, 
then  the  leading  physician  in  Cincinnati,  be- 
came devotedly  attached  to  the  young  man, 
seeing  in  him  the  promise  of  an  able  practi- 
tioner. This  friendship  was  later  cemented 
after  another  manner.  Dr.  McDowell  wooed 
and  won  the  sister  of  his  patron.  After  his 
marriage  to  Miss  Drake  he  removed  to  St. 
Louis,  and  it  was  there  that  he  built  for  himself 
a  reputation  for  skilful  surgery  and  remarkable 
determination  of  character,  that  not  even  time's 
destructive  touch  has  taken  from  him. 

Attached  to  the  college  was  one  of  the  most 
complete  museums  to  be  found  at  that  time  in 
the  land.  It  contained  an  attractive  and  ex- 
tensive collection  of  specimens  relating  to 
surgery,  rare  and  ancient  warlike  weapons, 
birds,  statuary,  and  many  things  of  interest. 
The  Doctor  was  fond  of  displaying  his  curiosi- 


JOSEPH  NASHE  MCDOWELL.  165 

ties  to  visitors,  and  no  one  thought  of  going  to 
St.  Louis  without  seeing  the  McDowell  Mu- 
seum. 

The  eccentricities  and  the  erratic  manner 
and  habits  of  Dr  Mc  Dowell  invited  many  com- 
ments and  severe  criticisms.  It  was  never 
questioned,  however,  that  he  was  a  man  of 
pronounced  learning,  and  as  well  a  genius  in 
his  profession. 

When  the  guns  of  Fort  Sumter  sounded  a 
knell  of  war  that  was  to  wreck  so  many  happy 
and  prosperous  families  both  in  the  north  and 
in  the  south :  when  the  echoes  resounded 
throughout  the  length  and  breadth  of  the 
land,  calling  men  to  arms — brother  against 
brother,  and  father  against  son,  men  hastily 
responded  to  the  call,  and  went  forth  to  battle, 
many,  alas,  to  fall  within  the  gates  of  their  own 
homes. 

Dr.  McDowell,  inspired  by  that  spirit  of 
chivalry  which  characterizes  the  American  peo- 
ple, offered  at  once  to  the  Confederates  his  ser- 
vices as  a  surgeon.  Bidding  adieu  to  his  family 
and  friends  in  St.  Louis,  he  was  assigned  duty 
in  Mississippi,  where  he  immediately  entered 
on  active  work. 

Many   wounded    and    gallant    soldiers   were 


1 66  JOSEPH  NASHE  MCDO  WELL. 

restored  by  his  skilful  operations  ;  his  efforts  to 
relieve  the  sick  and  wounded  were  unparalleled. 
He  was  out  night  and  day  on  his  mission  of 
mercy,  always  responding  punctually  to  the  call 
of  duty. 

The  writer  being  banished  from  New  Or- 
leans by  General  Benjamin  F.  Butler,  when  he 
occupied  that  city  during  the  late  civil  war,  had 
the  pleasure  of  meeting  Dr.  McDowell  on 
several  important  occasions. 

The  one  in  which  he  was  most  prominent 
and  took  a  very  conspicuous  part,  was  where  a 
dreadful  collision  occurred  between  two  trains 
freighted  with  many  people.  One  of  these 
cars  was  packed  with  wounded  soldiers,  fresh 
from  the  memorable  siege  of  Atlanta,  the  other 
coach  contained  refugee  ladies  with  their  help- 
less children  fleeing"  from  an  advancing  foe. 
On  board  the  soldiers'  train  there  were  many 
wounded  federal  soldiers  who  had  been  taken 
prisoners. 

Immediately  after  the  accident  (the  scene  of 
which  beggared  description)  surgeons  from 
every  rank,  and  ladies  by  the  hundred,  flocked 
to  the  scene  of  distress,  with  lint,  bandages, 
coffee,  camphor,  and  cologne,  all  of  them  ready 
and  willing  to  relieve  the  suffering  and  soothe 


JOSEPH  NASHE  MCDOWELL.  Y6"] 

the  dying  in  their  last  struggles.  The  blue 
and  the  gray  uniforms  mingled  together  upon 
their  beds  of  anguish,  anc[  ]3n  McDowell,  in 
his  kind,  benign  spirit,  administered  alike  to 
both  as  did  also  the  Southern  ladies.  Many  a 
Northern  soldier  owed  his  life  to  Dr.  McDowell 
and  to  Southern  women  on  that  occasion.  The 
question  was  not  then  asked,  "What  side  is  he 
on?"  Gentle  and  tender  hands  administered 
to  all  alike. 

On  another  occasion  the  writer  met  Dr. 
McDowell  under  different  circumstances,  when, 
his  feelings  being  greatly  outraged  toward  the 
North,  and  especially  toward  its  then  chief 
magistrate,  Abraham  Lincoln,  he  remarked  that 
"  to  him  was  due  all  the  terrible  sacrifice  of  life. 
That  to  him  was  due  this  civil  war." 

At  the  close  of  this  unfortunate  conflict  he 
returned  to  St.  Louis  an  embittered  man. 

His  college  was  a  wreck ;  his  handsome 
museum,  in  which  he  had  taken  so  much  pride, 
and  had  expended  so  much  money,  was  gone, 
not  a  vestige  of  anything  being  left  to  mark  the 
spot  where  once  were  crowded  so  many  things 
of  interest  to  him.  He  then  sought  his  once 
extensive  library.  Alas  !  only  to  find  the 
empty  shelves  standing  out  in  bold  relief,  as  if 


1 68  JOSEPH  NASHE  MCDO  WELL. 

in  defiance.  Not  a  book  was  to  be  found. 
The  bare  walls  of  the  once  famous  "  McDowell 
College"  were  left  standing  as  if  in  mockery. 
He  peered  through  the  broken  panes  of  glass 
(for  there  was  scarcely  a  whole  one  left  in  the 
building),  and  looking  out  into  what  was  once 
a  beautiful  garden  of  flowers,  tufted  with  grass, 
he  saw  filthy  debris  of  every  description,  to- 
gether with  the  remnant  of  a  gallows.  (The 
authorities  had  used  the  building  as  a  prison, 
and  the  once  cultivated  yard  had  been  made 
the  hangman's  ground ;  several  men  had  there 
expiated  their  crime  upon  the  gallows.)  The 
Doctor,  in  despair  and  gloom,  turned  from 
these  harrowing  scenes,  his  mind  quite  unset- 
tled as  to  what  was  best  to  be  done.  The 
ground  on  which  the  college  walls  were  left 
standing  still  belonged  to  him,  but  as  his  fi- 
nances were  running  low,  and  it  certainly  would 
be  necessary  to  expend  a  great  deal  of  money 
upon  the  building  before  it  could  be  made 
habitable,  he  was  truly  at  a  loss  as  to  how  he 
should  proceed. 

He  sought  the  advice  of  some  of  his  old  and 
trusted  friends  in  St.  Louis,  whom  he  knew 
had  his  interest  at  heart,  and  they  advised 
that   he    return    to    his   college,  and  with    the 


JOSEPH  NASHE  MCDO  WELL.  j  £q 

pecuniary  assistance  they  were  willing  to  give, 
that  he  put  things  in  readiness  to  recommence 
his  work. 

This  generous  offer  was  accepted,  and  in  a 
short  time  the  old  college  building  put  on  a 
new  dress. 

The  Doctor  had  a  crank  idea  that  in  that 
commodious  building-  one  room  should  be  set 
apart  and  designated  as  "Hell"  in  commemo- 
ration of  Abraham  Lincoln,  who,  although  long 
since  dead,  held  a  bitter  place  in  the  heart  of  the 
eccentric  old  doctor.  It  was  my  pleasure  to 
visit  my  relative  (Dr.  McDowell)  soon  after  he 
refitted  up  his  college  and  residence  ;  and  after 
his  congratulations  of  meeting  were  over,  he  re- 
marked that  he  wanted  to  take  me  to  "  Hell'1 
Not  comprehending  his  meaning,  I  replied:  "I 
hope  I  shall  never  be  so  unfortunate  as  to  see 
h— 1.  " 

He  immediately  caught  me  by  the  arm,  and 
leading  me  through  several  narrow  hallways, 
we  finally  halted  in  front  of  a  heavy  double 
door,  when  drawing  a  large  brass  key  from  his 
pocket  and  placing  it  in  the  lock,  the  door  soon 
yielded  and  swung  wide  open. 

I  noticed  as  I  passed  into  this  strange  room 
that  the  word  "Hell,"  in  gilt  letters,  stood  out 


I  70  JOSEPH  NA  SHE  MC  D  O  WEL  L . 

in  bold  relief  over  the  entrance.  The  room 
was  very  long-  and  narrow,  and  lacked  carpet  or 
other  furniture. 

On  entering  this  Dantean  abode,  the  first 
salutation  that  greeted  me  was  the  venomous 
hissing  of  an  unusually  large  rattlesnake  that 
was  to  be  seen  darting  out  its  fiery  tongue  be- 
tween the  bars  of  its  cage. 

To  the  left  a  huge  crocodile  was  noticed,  such 
as  crowd  the  southern  sloughs  and  bayous,  and 
dot  the  lowlands  and  canebrakes  of  the  tropical 
country.  The  hideous  reptile  crept  slothfully 
through  his  pool  of  tepid  water,  now  and  then 
swinging  his  immense  jaws  as  though  he  would 
like  to  make  a  meal  of  us  ;  but  he  too  was  con- 
fined within  his  own  limits,  and  there  was  no 
danger. 

Becoming  interested  in  this  weird  and  un- 
natural place  I  followed  the  Doctor,  not  unwill- 
ingly and  certainly  with  a  much  aroused  curi- 
osity, deeper  into  the  mysteries  of  his  "Hell!' 

Glancing  to  our  right,  we  saw  the  bird  of  ill 
omen  perched  upon  his  pole,  seemingly  oblivious 
of  us  or  of  its  surrounding ;  occasionally  it 
would  grit  its  bill  together,  causing  a  peculiarly 
unwelcome  sound.  Alongside  the  bird  was  a 
lizard,  singing  its  unvaried  song. 


JOSEPH  NASHE  MC D O  WELL.  l  y  r 

At  the  extreme  end  of  a  narrow  hall-like 
room  a  gallows  had  been  erected,  suspended 
from  which  was  an  effigy  of  ex-President  Abra- 
ham Lincoln.  For  a  moment  (the  scene  was 
so  life-like)  I  was  shocked  and  startled. 

There  were  several  other  images,  one  in  par- 
ticular representing  Lucifer  and  his  imps.  It 
was  indeed  a  novel  sight  to  witness.  Dr. 
McDowell  took  a  lively  interest  in  everything 
connected  with  this  particular  apartment. 

Before  the  late  civil  war,  in  the  ante-bellum 
days,  when  the  "  McDowell  Medical  College" 
was  at  its  height  of  prosperity,  and  several 
hundred  students  were  in  attendance,  upon  one 
occasion  a  very  distinguished  surgeon  and  phy- 
sician from  a  distance  was  to  lecture,  not  only 
before  the  students,  but  others. 

Dr.  McDowell,  being  at  that  time  the  Dean 
of  the  faculty,  had  sent  out  quite  a  number 
of  invitations  to  members  of  the  medical  pro- 
fession and  their  families. 

At  the  appointed  hour  for  the  lecture  to  begin 
the  spacious  hall  was  filled  with  many  of  the 
most  prominent  ladies  and  gentlemen  in  the  city. 

The  students  had  the  front  seats  reserved 
especially  for  them,  in  order  that  they  might 
hear  more  distinctly  what  the  professor  said. 


172  JOSEPH  NASHE  MCDOWELL. 

When  the  lecturer  was  nearly  half  through, 
Dr.  McDowell,  who  was  seated  upon  the  plat- 
form close  beside  the  speaker,  arose  to  his  feet, 
and  in  the  most  quiet  manner  possible  passed 
from  the  stage  up  the  aisle  to  where  one  of  his 
students  was  sitting,  laughing  and  talking  with 
a  young  lady.  He  (Dr.  McDowell)  took  him 
quietly  by  the  ear,  and  led  him  down  to  the 
front  seats  that  had  been  reserved  for  students, 
and  placed  him  in  front  of  the  speaker.  Dur- 
ing the  proceedings  not  a  word  was  spoken 
by  anyone.  After  the  student  had  been  seated, 
McDowell  took  his  same  place  near  the  pro- 
fessor. During  this  singular  performance  he 
did  not  change  a  muscle  of  his  face ;  of 
course,  the  audience  was  convulsed  with  laugh- 
ter, but  all  understood  why  the  young  man  had 
received  such  a  public  chastisement  from  his 
preceptor — he  was  not  in  his  place. 

The  eccentricities  of  Dr.  McDowell  were  so 
great  that  had  he  lived  in  the  present  time  his 
warmest  friends  would  have  been  constrained 
to  classify  him  with  the  legion  of  "  cranks." 
His  many  peculiar  acts  and  idiosyncrasies  would 
certainly  have  justified  such  placing. 

Although  never  really  acknowledging  his 
belief  in  spiritualism,  yet  when   any  noted  lee- 


JOSEPH  NASHE  MCDO  WELL.  173 

turer  on  that  subject  was  in  the  city  the  doctor 
was  always  found  among  the  audience.  Dr. 
Tuckett,  an  intimate  friend,  relates  the  following 
conversation  had  with  him  : 

'•  I  see  that  you  listen  to  the  spirits  some- 
times." "Yes,"  was  the  reply,  "there  is  agreat 
deal  more  in  the  matter  than  a  man  can  ex- 
press without  being  thought  a  d — n  fool." 

"  You  are  right,"  was  added.  "  But  have  you 
ever  had  an  experience  or  seen  any  manifesta- 
tions ?"  "  Yes  ;  a  confounded  sight  more  than 
I  tell  people.  However,  I  will  tell  you,"  he 
continued,  "what  I  know,  and  how  I  was  saved 
by  my  mother's  spirit." 

"  A  German  girl  died  with  a  very  unusual 
disease,  and  we  were  determined  to  get  her 
body  for  dissection.  We  got  it  and  laid  it  in 
the  college.  The  secret  leaked  out,  and  the 
Germans  got  their  backs  up  and  made  things 
lively  for  us.  It  was  planned  by  them  to  come 
one  night  and  hunt  over  the  college  to  see  if 
the  body  was  there  to  be  dissected. 

"  I  received  a  note  at  my  house  at  9  o'clock 
of  an  evening  warning  me  that  the  visit  was  to 
be  that  night. 

"  I  went  down  to  the  college  about  1 1  o'clock, 
thinking  to  hide  the  corpse.     When  I  got  there 


174  JOSEPH  NASHE  MCDOWELL. 

all  was  quiet.  I  went  through  the  dissecting 
room,  with  a  small  lantern  in  my  hand,  in  the 
direction  of  the  body.  I  picked  the  cadaver  up 
and  threw  it  over  my  shoulder  to  carry  it  to 
the  top  loft  to  conceal  it  between  the  rafters, 
or  place  it  in  a  cedar  chest  that  had  stood  in  a 
closet  for  years. 

"I  had  ascended  one  flight  of  stairs,  when 
out  went  my  lamp.  I  laid  down  the  corpse 
and  re-struck  a  light.  I  then  picked  up  the 
body,  when  out  went  my  light  again.  I  felt 
for  another  match  in  my  pocket,  when  I  dis- 
tinctly saw  my  dear,  old  mother  standing  a 
little  distance  off,  beckoning  to  me. 

"In  the  middle  of  the  passage  was  a  window ; 
I  saw  her  rise  in  front  of  it.  I  walked  along 
close  to  the  wall,  with  the  corpse  over  my 
shoulder,  and  went  to  the  top  loft  and  hid  it. 
I  came  down  in  the  dark,  for  I  knew  the  way 
well :  as  I  reached  the  window  in  the  passage, 
there  were  two  Germans  talking,  one  had  a 
shotgun,  the  other  a  revolver.  I  kept  close 
to  the  wall  and  slid  down  the  stairs.  When  I 
got  to  the  dissecting-room  door,  I  looked  down 
the  stairs  into  the  hallway:  there  I  saw  five  or 
six  men  lighting  a  lamp.  I  hesitated  a  moment 
as  to  what  I  should  do,  as  I  had  left  my  pistols 


JOSEPH  NASHE  MCD  O  WELL.  \  y  5 

in  my  pocket  in  the  dissecting-room  where  I 
took  the  body.  I  looked  in  the  room,  as  it 
was  my  only  chance  to  get  away,  when  I  saw 
my  spirit  mother  standing  near  the  table 
from  which  I  had  just  taken  the  corpse.  I  had 
no  light,  but  the  halo  that  surrounded  my 
mother  was  sufficient  to  enable  me  to  see  the 
table  quite  plainly. 

"  I  heard  the  men  coming  up  the  stairs.  I 
laid  down  whence  I  had  taken  the  body  and 
pulled  a  cloth  over  my  face  to  hide  it.  The 
men  came  in,  all  of  them  being-  armed,  to  look 
at  the  dead.  They  uncovered  one  body — it 
was  that  of  a  man,  the  next  a  man  ;  then  they 
came  to  two  women  with  black  hair — the  girl 
they  were  looking  for  had  light  flaxen  hair. 
Then  they  passed  me ;  one  German  said : 
'  Here  is  a  fellow  who  died  in  his  boots ;  I 
guess  he  is  a  fresh  one.' 

"  I  laid  like  marble.  I  thought  I  would  jump 
up  and  frighten  them,  but  I  heard  a  voice,  soft 
and  low,  close  to  my  ear,  say,  '  Be  still,  be  still.' 
The  men  went  over  the  building  and  finally 
down  stairs.  I  waited  awhile,  then  slipped  out. 
At  the  corner  of  Gratiot  Street,  I  heard  three 
men  talking  German  ;  they  took  no  notice  of 
me,  and  I  went  home. 


jy6  JOSEPH  NASHE  MCDOWELL. 

"  Early  in  the  morning  I  went  to  the  college 
and  found  everything  all  right.  We  dissected 
the  body,  buried  the  fragments  and  had  no  fur- 
ther trouble.  " 

"  Then,  Doctor,  you  feel  satisfied  that  the 
spirit  of  your  mother  saved  you  from  that 
trouble  ? 

"I  know  it,"  he  replied.  "I  often  feel  as 
though  my  mother  is  near  me  when  I  have  a 
difficult  case  of  surgery.  I  am  always  success- 
ful when  I  feel  this  influence.  Well,  let  me 
stop  here.  I  have  a  boy  to  attend  to  with  a 
broken  leg,  so  good-bye."  And  with  his  char- 
acteristic manner  of  always  being  in  a  great 
hurry,  he  glided  out  the  door  and  into  his 
buggy. 

He  was  very  fond  of  the  violin,  and  played 
many  of  the  old  popular  airs.  It  was  his  cus- 
tom to  amuse  his  friends  when  they  would  call 
upon  him  socially,  by  playing  familiar  tunes  for 
them. 

His  death  occurred  October  3,  1868.  Three 
sons  survived  him.  He  was  singularly  unlike 
any  of  his  McDowell  kindred. 

Two  of  his  sons,  Drs.  Drake  and  John 
McDowell,  arrived  at  considerable  eminence 
in  the  medical  profession  ;  both  filled  chairs  in 


JOSEPH  NASHE  MCD O  WELL.  :  -  ~ 

anatomy  and  obstetrics.  Indeed,  John  Mc- 
Dowell was  considered  equal  to  his  father  in 
difficult  operations.  He  had  a  lucrative  prac- 
tice.    All  three  of  the  sons  are  dead. 

The  peculiarities  of  the  father  seem  to  have 
been  inherited,  to  a  certain  extent,  by  his  son 
John. 

On  one  occasion  he  drove  up  to  his  relative's 
house  in  St.  Louis  to  make  a  social  call.  On 
entering  the  parlors  he  found  quite  a  number 
of  ladies  and  gentlemen  there  spending  the 
evening-.  When  tea  was  announced  he  arose 
to  take  his  departure,  excusing  himself  to  his 
hostess,  but  she  would  not  permit  him  to  go. 
After  all  the  guests  had  entered  the  dining- 
room  Dr.  McDowell  detected  that  there  were 
twelve  at  the  table,  and  that  his  presence  made 
the  thirteenth.  He  refused  to  be  seated ;  his 
relative  bantered  him  with  being  superstitious, 
when  he  replied:  "Well,  my  cousin,  in  honor 
to  you  I  will  take  my  seat,  but  as  my  presence 
makes  the  thirteenth  /will  be  the  first  one  from 
this  fatal  number  who  will  pass  away." 

He  ate  sparingly  and  the  thought  certainly 
took  possession  of  his  mind,  for  he  alluded  to 
the  circumstance  repeatedly,  and,  true  to  his 
predictions,  in  a  few  weeks  thereafter  he  died. 


178  JOSEPH  NASHE  MCDOWELL. 

A  few  years  before  his  death  Dr.  Joseph 
Nashe  McDowell  married  again :  but  the  alli- 
ance did  not  prove  a  happy  one  ;  his  children 
wandered  from  home,  and  the  old  doctor  sought 
comfort  and  solace  in  the  Roman  Catholic 
religion. 

When  the  iron  grasp  of  death  was  upon 
him,  claiming  him  as  its  victim,  he  calmly  closed 
his  eyes,  passing  thus  to  the  great  hereafter, 
bearing  with  him  the  loving  benediction  of 
his  faithful  friend  and  spiritual  adviser,  Father 
De  Smit. 

From  the  early  experience  of  his  Romanistic 
convictions,  this  Father  De  Smit  was  his  re- 
ligious adviser  and  companion.  Dr.  McDowell 
reverenced  him  for  his  piety,  admired  him  for 
his  intellect,  and  regarded  him  as  the  soul- 
healer  and  spiritual  comforter  of  those  op- 
pressed by  sin  and  wickedness. 

Before  we  close  this  brief  memoir  of  a  gifted 
and  remarkable  man,  we  may  relate  another 
circumstance  pointing  to  his  peculiar  nature  and 
eccentricities.  The  idiosyncrasy  relates  to  his 
unnatural  and  unheard-of  mode  of  interring 
his  infant  children.  After  death  had  claimed 
them,  and  they  were  robed  in  their  burial  dress 
and  ready  for  the  burial  rites,  he  would  order 


JOSEPH  NASHE  MCDO  WELL.  j  yg 

the  casket,  which  he  had  prepared  expressly 
for  the  solemn  occasion.  This  casket  wasmade 
of  heavy  glass,  and  filled  with  alcohol ;  the  body 
of  the  infant  was  placed  within  the  case  con- 
taining the  liquid,  and  the  coffin  securely 
cemented. 

Only  the  undertaker  and  the  nearest  kindred 
followed  the  remains  to  an  island  (several  miles 
distant  from  the  city)  in  the  Mississippi  River, 
where  the  grave  had  been  prepared,  and  there 
the  casket  was  lowered  into  the  earth. 

After  the  death  of  the  Doctor  his  surviving 
sons  had  the  infantile  remains  removed  to  the 
family  lot  in  Bellfontaine  Cemetery  and  placed 
beside  those  of  the  father,  where  their  little 
graves  could  not  be  disturbed  by  rises  in  the 
river. 

A  singular  coincidence  :  three  surgeons  be- 
longing to  the  same  family,  each  having 
achieved  professional  honors  and  having  risen 
to  eminence  in  the  medical  world,  now  resting 
side  by  side  in  the  beautiful  "Bellfontaine" 
burying  ground.  We  can  only  say,  "  Peace  be 
to  their  ashes!' 

In  reading  a  biographical  sketch  of  the  late 
Col.  Basil  Duke,  whose  mother  was  Martha 
McDowell,  a  member  of  the  Virginia  family  of 


1 80  JOSEPH  NASHE  MCDO  WELL . 

McDowells,  we  find  the  fact  established  that 
more  than  forty  years  after  the  death  of  Dr. 
Ephraim  McDowell,  the  European  people 
awakened  to  the  fact  that  Dr.  McDowell  was 
justly  entitled  to  be  called  the  "  Father  of  ovari- 
otomy," and  acting  on  such  conviction  erected 
a  suitable  monument  to  his  memory. 

Can  this  be  repeated  of  America,  the  land 
of  his  birth  ?  Has  a  national  monument  been 
erected  to  him  who  was  truly  woman's  bene- 
factor ? 

The  late  Dr.  Jackson,  in  appropriate  re- 
marks, seemed  fully  to  appreciate  the  fact  that 
America  had  failed  to  do  her  duty  toward  this 
worthy  son  of  her  land.  America,  the  country 
that  pays  tribute  to  merit  and  genius — that  so 
fully  appreciates  intellect,  seems  here  to  have 
shrunk  from  her  duty ;  yet  the  memory  of 
Dr.  McDowell  is  as  fresh  in  the  hearts  of  the 
people  to-day  as  when  he  braved  his  own  life 
for  humanity's  sake. 


CHAPTER   XI. 

BIOGRAPHICAL    SKETCH    BY    THE    LATE 
DR.    JOHN    D.   JACKSON. 

Through  the  kindness  of  Dr.  Lewis  S. 
McMurtry,  we  have  been  furnished  a  full  ac- 
count of  the  character  and  services  of  Dr. 
Ephraim  McDowell,  prepared  and  written  by 
the  late  Dr.  John  D.  Jackson,  of  Danville, 
Kentucky,  a  gentleman  who  devoted  much 
time  during  the  latter  days  of  his  life  in  gather- 
ing facts  relative  to  Dr.  McDowell,  for  whose 
character  and  works  he  had  great  veneration. 

Dr.  Jackson  says  : 

For  a  quarter  of  a  century,  or  indeed  until 
Dr.  Benjamin  W.  Dudley,  of  Lexington,  Ken- 
tucky, came  upon  the  field  as  a  lecturer  upon 
surgery,  Dr.  McDowell  yearly  came  before 
large  classes  of  young  men  "assembled  at  the 
medical  department  of  Transylvania  University 
from  all  portions  of  the  Ohio  and  Mississippi 
valleys,  thus  possessing  opportunity  for  extend- 
ing a  reputation  such  as  no  man  in  the  West 
ever   had   before  him.     We  may  say  that   he 

(iSi) 


j  g  2  SKE  TCH  B  Y  DR.  JOHN  D.  J  A  CKSON. 

stood  "  facile  princeps  "  in  surgery  west  of  the 
Allegfhenies. 

During  this  time  McDowell's  practice  ex- 
tended in  every  direction,  persons  came  to 
him  for  treatment  from  all  the  neighboring 
States,  and  he  frequently  took  horseback 
journeys  for  hundreds  of  miles.  He  is.  to  be 
accepted  as  being  in  the  habit  of  performing 
every  surgical  operation  then  taught  in  the 
science. 

In  lithotomy  he  was  extremely  successful. 
Up  to  1828  he  was  known  to  have  operated 
twenty-two  times  without  a  death. 

For  strangulated  hernia  he  also  operated  in 
a  large  number  of  cases,  and  there  is  good 
authority  for  stating  that  he  successfully 
extirpated  the  parotid  gland  long  before 
McClellan  or  any  other  American  surgeon  had 
attempted  the  procedure. 

Indeed  there  was  scarcely  any  operation, 
from  a  simple  amputation  to  tracheotomy, 
which  was  to  be  done,  but  that  Dr.  McDowell 
was  sent  for  to  perform  it. 

The  brevity  and  rather  loose  manner  in 
which  his  first  cases  were  recorded,  exposed 
him  to  criticism,  and  Dr.  Henderson  and  Dr. 
Michener,    of   Philadelphia,    in    articles    in    the 


SKE  TCH  B  Y  DR.  JOHN  D.  J  A  CKSON.  j  8  3 

Repertory,  reviewed  him  rather  sarcastically 
and  doubtingly ;  while  Dr.  James  Johnson, 
the  caustic  editor  of  the  London  Medico- 
Chirurgical  Review,  did  not  hesitate  to  take 
advantage  of  the  opportunity  and  declare  out- 
right his  total  disbelief  as  to  Dr.  McDowell's 
statements.  A  few  years  thereafter,  when 
accuracy  of  the  reports  had  been  fully  con- 
firmed, he  however  acknowledged  his  previous 
error,  though  in  a  flippant  and  very  ungraci- 
ous manner;  saying:  "A  back  settlement  of 
America — Kentucky — has  beaten  the  mother 
country,  nay  Europe  itself,  with  all  the  boasted 
surgeons  thereof,  in  the  fearful  and  formidable 
operation  of  gastrotomy  with  extraction  of  the 
diseased  ovaria There  were  circum- 
stances in  the  narratives  of  some  of  the  first 
three  cases  that  raised  misgivings  in  our  minds, 
for  which  uncharitableness  we  ask  pardon  of 
God,  and  of  Dr.  Macdowal,  of  Danville." 

In  the  Philadelphia  Eclectic  Repertory  for 
October,  1819,  Dr.  McDowell  reported  two 
more  cases,  and  in  connection  with  them  alluded 
incidentally  to  his  critics  and  their  criticism  to 
this  effect : 

"I  thought  my  statement  sufficiently  explicit 
to  warrant  any  surgeon  performing  the  opera- 


!  84  SKE  TCH  B  Y  DR.  JOHN  D.  J  A  CKSON. 

tion,  when  necessary,  without  hazarding  the 
odium  of  making-  an  experiment;  and  I  think 
my  description  of  the  mode  of  operating,  and 
of  the  anatomy  of  the  parts  concerned,  clear 
enough  to  enable  any  good  anatomist,  possess- 
ing the  judgment  requisite  for  a  surgeon,  to 
operate  with  safety.  I  hope  no  operator  of 
any  other  description  may  ever  attempt  it. 
It  is  my  most  ardent  wish  that  this  operation 
may  remain  to  the  mechanical  surgeon  for- 
ever incomprehensible.  Such  have  been  the 
bane  of  the  science ;  intruding  themselves 
into  the  ranks  of  the  profession  with  no 
other  qualification  but  boldness  in  undertaking, 
ignorance  of  their  responsibility,  and  indiffer- 
ence to  the  lives  of  their  patients ;  proceeding 
according  to  the  special  dictates  of  some 
author  as  mechanical  as  themselves,  they  cut 
and  tear  with  fearless  indifference,  utterly  in- 
capable of  exercising  any  judgment  of  their 
own  in  cases  of  emergency,  and  sometimes 
without  possessing  even  the  slightest  knowl- 
edge of  the  anatomy  of  the  parts  concerned. 
The  preposterous  and  impious  attempts  of 
such  pretenders  can  seldom  fail  to  prove 
destructive  to  the  patient  and  disgraceful  to 
the  science.     It  is  by  such  this  noble  science 


SKE  TCH  B  Y  DR.  JOHN  D.  J  A  CKSOX.  j  8  5 

has  been  degraded,  in  the  minds  of  many,  to 
the  rank  of  an  art." 

Dr.  Jackson  goes  on  to  relate : 

In  the  summer  of  1822,  McDowell  made  a 
horseback  journey  of  some  hundreds  of  miles 
into  middle  Tennessee,  and  performed  ovari- 
otomy in  his  usual  way,  with  success,  upon  a 
Mrs.  Overton,  who  resided  near  the  "Hermit- 
age," the  residence  of  the  late  President  Jackson. 

Mrs.  Overton  was  enormously  obese,  and 
he  had  to  cut  through  four  inches  of  fat  upon 
the  abdomen.  The  only  assistance  he  had  in 
the  operation,  as  we  have  been  informed,  was 
from  General  Jackson  and  a  Mrs.  Priestly. 

General  Jackson  seems  to  have  been  greatly 
impressed  with  Dr.  McDowell,  and  had  him 
go  to  his  house  and  remove  a  large  tumor 
growing  from  the  neck  and  shoulders  of  one 
of  his  men. 

Dr.  McDowell  charged  for  his  operation  upon 
Mrs.  Overton  $500,  but  the  husband,  with  a 
commendable  generosity,  gave  a  check  upon 
one  of  the  Nashville  banks  for  $1500,  which, 
upon  the  doctor  presenting  for  payment,  and 
discovering  the  presumed  error  for  the  first 
time,  sent  a  messenger  back  to  Mr.  Overton 
to    have   it   corrected,   but    that  gentleman  re- 


T  86  SKE  TCH  B  Y  DR.  JOHN  D.  J  A  CKSON. 

plied  that,  far  from  a  mistake,  he  felt  that  he 
had  not  even  then  made  a  full  compensation 
for  the  great  services  which  Dr.  McDowell  had 
rendered. 

How  many  times  during  his  career  he  had 
occasion  to  perform  ovariotomy  is  not  now  cer- 
tainly known.  He  seems  to  have  been  fonder 
of  the  scalpel  than  of  the  pen — indeed,  to  have 
been  of  that  class  of  mankind  (of  which  we  have 
all  seen  specimens,  even  among  the  ablest  and 
most  cultivated)  who  have  a  natural  antipathy 
to  writing. 

He  is  said  to  have  kept  no  notes  of  his  cases, 
and  with  the  exception  of  the  communications 
quoted,  we  know  alone  of  a  card  published  in 
1826,  when  an  effort  was  made  to  wrest  his 
honors  from  him  ;  this  he  addressed  especially 
to  the  medical  faculty  and  class  at  Lexington, 
defending  his  veracity  and  claiming  to  have 
been  the  first  to  perform  and  establish  the 
feasibility  of  the  removal  of  diseased  ovaries. 

However,  his  nephew,  Dr.  William  A.  Mc- 
Dowell, who  was  for  five  years  his  pupil  and 
two  years  his  partner,  tells  us  that  up  to  1820 
his  uncle  had  seven  cases,  six  of  which  he  wit- 
nessed, and  that  six  of  the  seven  were  success- 
ful. 


SKE  TCH  B  Y  DR.  JOHN  D.  J  A  CKSON.  j  g  y 

After  Dr.  William  A.  McDowell  removed 
from  Kentucky  to  Fincastle,  Virginia,  Dr.  Alban 
G.  Smith  succeeded  to  his  position  as  partner 
of  Dr.  Ephraim  McDowell,  and  while  with  him 
Dr.  Smith  twice  performed  ovariotomy. 

The  younger  McDowell  stated  that  he  had 
reliable  testimony  of  his  uncle  having  per- 
formed ovariotomy  during  his  life  at  least 
thirteen  times,  exclusive  of  the  two  cases  Dr. 
Smith  operated  upon  when  they  were  in  part- 
nership, and  that  of  the  cases  treated  by  his 
uncle,  subsequent  to  his  retiring  from  partner- 
ship, he  had  personal  knowledge  of  the  recovery 
of  two ;  this  would  make  a  total  of  thirteen 
cases  with  eigfht  recoveries. 

Dr.  Ephraim  McDowell  seems  to  have  been 
very  careless  either  of  an  immediate  present 
or  posthumous  fame,  and  to  have  originally 
drawn  up  the  report  of  his  cases  at  the  re- 
peated solicitation  of  his  nephew,  Dr.  James 
McDowell,  who,  up  to  the  time  of  his  prema- 
ture death,  had  been  a  partner  of  his  uncle,  as 
his  cousin  William,  to  whom  we  have  alluded, 
afterward  was. 

The  idea  that  his  success  would  be  pleasing 
to  his  former  preceptor,  John  Bell,  to  whom  he 
felt  he  owed  his  determination  to  perform  the 


1 88  SKE  TCH  B  Y  DR.  JOHN  D.  J  A  CKSON. 

operation,  according  to  his  nephew,  seemed 
more  than  all  else  to  have  induced  him  to  put 
his  cases  before  the  professional  world. 

Long  after  all  dispute  as  to  the  authenticity  of 
Dr.  McDowell's  cases  had  ceased,  the  medical 
literature  of  the  past  was  ransacked  to  find  some 
one  who  had  preceded  him  in  the  operation. 
Indeed,  until  the  critical  examination  made  by 
Dr.  Gross,  it  was  believed  that  L'Aumonier, 
Dzonde,  Galenzowski,  had  all  preceded  him  by 
having  each  done  a  single  ovariotomy.  Going 
to  the  original  records  of  these  gentlemen, 
it  was  found,  however,  that  the  first  had  only 
punctured  an  abscess  of  the  ovary,  that 
Dzonde's  case  was  simply  one  of  gastrotomy 
upon  a  boy  who  had  a  pelvic  tumor,  and 
that  Galenzowski' s  case,  while  really  an  im- 
perfect ovariotomy,  was  not  done  until  1827, 
eighteen  years  after  the  first  operation  by 
McDowell. 

When  McDowell  performed  his  first  opera- 
tion he  had  never  heard,  as  he  said  in  the  publi- 
cation made  of  it,  of  an  attempt  at  or  a  success 
attending  any  operation  such  as  this  required. 

At  present  we  are  not  aware  that  even  the 
most  persevering  antiquarian  research  has  been 
able  to  find  undoubted  ovariotomy  before  the 


SKE  TCH  B  Y  DR.  JOHN  D.  J  A  CKSON.  l  $g 

time  of  McDowell,  for  although  we  observe 
that  Mr.  Spencer  Wells,  in  his  recently  pub- 
lished History  of  the  Origin  and  Progress  of 
Ovariotomy,  says,  on  the  authority  of  Dr.  Wash- 
ington Atlee,  "Dr.  Robert  Houstoun  operated 
near  Glasgow  in  1701,  and  that  from  this  case 
it  will  appear  that  ovariotomy  originated  with 
British  surgery,  on  British  ground."  Yet  a 
reference  to  the  original  record  shows  very 
plainly  that  Dr.  Houstoun  was  never  really  an 
ovariotomist  in  the  sense  of  having  removed 
an  ovary ;  his  operation,  like  L'Aumonier's, 
consisting  in  laying  open  the  diseased  ovary 
and  evacuating  a  large  quantity  of  gelatinous 
fluid,  when  as  he  says,  "  I  squeezed  out  all  I 
could  and  stitched  up  the  wound  in  three 
places  almost  equidistant." 

We  observe  that  Dr.  Atlee,  in  his  volume  on 
Ovarian  Tumors,  dedicates  the  book  to  his 
brother,  Dr.  John  L.  Atlee,  and  to  the  memory 
of  Dr.  Ephraim  McDowell,  "The  Father  of 
Ovariotomy."  Even  had  the  operation  been 
done  many  times  before,  or  been  forgotten  or 
unnoticed,  as  the  cases  lay  among  the  dead 
records  of  the  past,  it  should  not,  and  it  would 
not,  derogate  at  all  from  the  glory  of  Dr.  Mc- 
Dowell, who  never  had  heard  of  any  attempt 


j  Q0  SKE  TCH  B  Y  DR.  JOHN  D.  J  A  CKSON. 

to  perform  it,  and  who,  after  his  performance 
of  it,  first  succeeded  in  establishing  it  as  a 
legitimate  operation  in  the  medical  world. 

When  we  think  of  one  living  on  the  border 
of  Western  civilization,  in  a  little  town  of  be- 
tween three  and  four  hundred  inhabitants,  far 
removed  from  the  opportunity  of  consultation 
with  any  one  whose  opinions  might  be  of 
value  to  him  in  such  a  case,  and  nearly  a  thous- 
and miles  from  the  nearest  hospital  or  col- 
lege dissecting-room  at  which  he  might  have 
had  an  opportunity  of  studying  and  practising 
upon  some  body  who  had  perished  of  the  dis- 
ease, before  performing  upon  the  living  a  new 
and  untried  operation  of  such  fearful  magni- 
tude ;  and  learn  of  his  having  pondered  over 
and  contemplated  all  the  difficulties,  when  with 
a  full  sense  of  the  dangers  liable  to  environ 
him  in  the  attempt,  without  ether  or  chloro- 
form, assisted  by  probably  only  one  fully 
skilled  physician  or  assistant,  with  one  or  two 
medical  students — see  him  attempt  and  success- 
fully perform  the  first  ovariotomy — our  admi- 
ration for  Dr.  Ephraim  McDowell's  courage 
and  skill  rises  to  its  full  height,  and  we  feel 
that  he  is  justly  entitled  to  have  applied  to 
him  Horace's  words,   describing  the  stoutness 


SKE  TCH  BY  DR.  JOHN  D.  J  A  CKSON.  \  g  i 

of  the  heart  of  the  first  mariner  who  had  bold- 
ness to  go  down  to  the  sea  in  ships : 

Mi  robur  et  aes  triplex 
Circa  pectus  erat,  qui  fragilem  truci 

Commisit  pelago  ratem 
Primus. 

Dr.  Ephraim  McDowell  was  always  remark- 
able for  his  strength  and  agility,  and  while  at 
Edinburgh  was  pronounced  the  swiftest  foot- 
racer  of  the  whole  University.  He  was  one  of 
the  kindest-hearted  and  most  amiable  of  men, 
overflowing  with  cheerfulness  and  good  humor. 
He  seemed  totally  devoid  of  all  austerity,  a 
tinge  of  which  is  generally  characteristic  of  the 
scholar  and  professional  man,  and  never  ap- 
peared to  assume  that  there  was  any  difference 
between  the  plane  of  his  vocation  and  that  of 
the  humblest,  unlettered  artisan. 

This  seemed  instinctively  to  strike  all  who 
came  in  contact  with  him,  and  an  easiness 
amounting  almost  to  familiarity  existed  be- 
tween him  and  his  fellow-citizens.  So  true  was 
this  with  the  masses,  that  probably  because  of 
such  fact  he  was  not  generally  appreciated  for 
his  true  worth. 

A  man  arrogating  to  himself  in  manner 
nothing  above  the  populace,  would  not,  as  may 


I  g  2  SKE  TCH  B  Y  DR.  JOHN  D.  J  A  CKSON. 

readily  be  believed,  be  acknowledged  to  be 
superior  to  his  sphere,  save  by  those  gifted 
above  common  penetration.  Never,  however, 
was  this  air  of  familiarity  in  the  slightest  degree 
tinctured  with  professional  demagoguery.  His 
bitterest  enemies  did  not  once  accuse  him  of 
this. 

By  a  gentleman  of  keen  perception,  yet 
living,  whose  father's  family  physician  he  was, 
we  are  told  that  never  was  there  a  man  whose 
life  was  freer  from  the  acts  of  the  charlatan, 
or  more  entirely  devoid  of  all  the  petty  "tricks 
of  trade"  which  too  frequently  disgrace  the 
medical  profession. 

While  in  the  sick-room,  though  fond  of  gos- 
siping about  local  matters  and  events  of  the 
day,  he  habitually  refrained  from  discussing 
things  medical,  or  any  of  the  affairs  of  his 
rivals,  with  some  of  whom  he  was  known  to  be 
on  anything  but  good  terms. 

While  in  daily  competition  with  certain  mem- 
bers of  the  profession  whose  chief  strength 
lay  in  the  application  of  such  arts,  they  and 
their  artifices  were  held  in  supreme  contempt 
by  him.  From  what  we  can  learn,  one  of  the 
endeavors  of  these  gentlemen,  who  knew  they 
never  could  approach  McDowell  by  fair  com- 


SKE  TCH  B  Y  DR.  JOHN  D.  JA  CKSON.  193 

petition,  was  to  impress  the  community  with 
the  idea  that  there  was  a  sort  of  essential  in- 
compatibility between  surgery  and  medicine  ; 
that  in  proportion  as  a  man  is  superior  in  sur- 
gical knowledge  and  dexterity,  that  by  just  so 
much  is  he  inferior  in  the  intricacies  of  the 
practice  of  medicine,  whose  arcana  were  not  so 
appreciably  evident  to  the  public  as  the  more 
demonstrable  work  of  the  surgeon  ;  or,  as  they 
were  in  the  habit  of  putting  it :  "  That  while 
McDowell  was  a  bold  surgeon,  he  was  but  a 
poor  fever  doctor." 

So  far  from  this  last  being  the  case,  however, 
he  kept  himself  fully  abreast  of  the  progress  of 
medicine  by  reading  all  that  was  new  on  the 
subject,  and  was  probably  really  as  far  in  ad- 
vance of  his  competitors  in  physic  as  in  sur- 
gery. 

Certainly  we  now  know  that  in  the  treat- 
ment of  fever  he  was  in  some  respects  ahead 
of  his  time,  though  at  variance  with  the  gener- 
ally accepted  doctrine  of  his  day  and  the  pre- 
vailing customs  of  the  physicians  of  his  section. 
At  that  time  it  was  customary  to  give  more  or 
less  mercury  in  the  treatment  of  every  fever, 
while  to  allow  a  patient  cold  water  after  a  dose 
of  calomel   or  blue  mass   was   thought  to   be 


1 94  SKE  TCH  B  Y  DR.  JOHN  D.  J  A  CKSON. 

recklessly  dangerous.  The  standard  treat- 
ment of  the  country  was  to  let  a  patient  have 
no  drink  but  what  had  been  warmed  ;  and  this 
usually  consisted  of  water  in  which  a  piece  of 
burnt  bread-crust  or  warm  toast  had  been 
soaked.  On  the  contrary,  Dr.  McDowell  used 
to  tell  his  patients  that  there  was  no  danger  in 
cold  water  while  the  skin  was  hot ;  and  while 
such  was  the  case  he  allowed  them  to  use  it 
ad  libitum. 

I  have  heard  an  old  gentleman,  who  lived  in 
an  adjoining  county,  tell  how,  when  he  was  a 
boy,  and  one  of  his  brothers  lay  very  ill  with  a 
fever,  Dr.  McDowell  was  sent  for;  and  of  the 
anxious  fears  of  the  family  while  obeying  the 
directions  of  the  doctor,  who  had  the  patient 
laid  naked  upon  the  floor,  and  bucketful  upon 
bucketful  of  cold  water  poured  over  him  to  his 
great  relief  and  ultimate  recovery. 

Dr.  McDowell  looked  on  Sydenham  and 
Cullen  as  the  master  minds  in  medicine,  and 
set  their  works  above  all  others  in  practice. 

To  the  system  of  over-drugging,  then  so 
common,  he  was  an  enemy ;  believing  that 
drugs  as  then  given  by  the  mass  of  the  profes- 
sion, without  discrimination,  were  producing  in 
the  aggregate  more  harm  than  good.     Though 


SKE  TCH  BY  DR.  JOHN  D.  J  A  CKSON.  I  g  r 

practising  medicine  with  more  than  ordinary 
ability,  yet  his  inclinations  were  always  espe- 
cially toward  surgery ;  and  it  was  his  custom, 
when  practicable,  to  throw  as  far  as  possible 
the  medical  practice  into  the  hands  of  his 
partner. 

He  was  a  most  accomplished  anatomist,  and 
used  every  winter,  in  conjunction  with  his  office 
students,  of  whom  he  generally  had  two  or 
three,  to  dissect  in  the  upper  story  of  an  old 
abandoned  building,  which  had  for  years  been 
the  county  jail  ;  and  in  his  office,  in  the  course 
of  time,  quite  a  number  of  anatomical  prepa- 
rations, the  work  of  his  own  hands,  were 
deposited. 

When  having  determined  upon  the  perform- 
ance of  any  capital  operation,  his  custom  was 
to  drill  thoroughly  beforehand  the  students  who 
were  to  assist  him.  Not  only  this,  but  he  com- 
pelled each  one  to  give  a  succinct  history  of 
the  nature  of  the  difficulty  requiring  the  opera- 
tion, the  anatomy  of  the  parts  involved,  and  the 
tissues  to  be  divided,  and  then  would,  himself, 
rehearse  the  different  steps  of  the  operation. 

It  was  the  invariable  opinion  of  all  compe- 
tent judges  that  for  coolness  and  dexterity  as  an 
operator  they  had  never  seen  Dr.  McDowell's 


1 96  SKE  TCH  B  Y  DR.  JOHN-  D.  J  A  CKSON. 

equal.  From  the  moment  he  took  the  knife  in 
hand  preparatory  to  operating,  he  seemed  to 
become  enthused,  and  to  the  bystanders  looked 
quite  a  different  person.  When  we  consider 
the  results  to  mankind  of  the  labors  of  this 
surgeon,  we  do  not  hesitate  to  rank  him  with 
the  great  benefactors  of  the  race. 

Before  the  nineteenth  century,  not  one  of  the 
most  astute  or  boldest  of  the  healing  profession 
could  promise  anything  hopeful  to  women  af- 
flicted with  ovarian  dropsy.  The  doctor  when 
called  to  such  a  case,  could  only  say,  "Two 
years  of  life  filled  with  gradually  increasing 
misery  is  the  full  compass  of  the  days  allotted 
to  a  woman  who  may  find  that  she  has  an  ova- 
rian tumor,  and  unless  God  works  a  miracle 
in  your  case,  this  is  your  fate." 

But  now,  since  the  establishment  of  ovari- 
otomy by  Ephraim  McDowell,  the  matter 
stands  quite  differently,  for  the  physician  of 
our  era  says,  "It  is  true  that  without  an  opera- 
tion you  are  inevitably  doomed  to  death  after  a 
few  years  of  miserable  suffering,  but  by  ovari- 
otomy you  have  seventy  chances  or  even  more 
out  of  a  hundred  (much  better  than  one  under- 
going the  amputation  of  a  thigh),  not  only  of 
recovery,  but  of  a  full  restoration  to  health." 


SKE  TCH  B  Y  DR.  JOHN  D.  J  A  CKSON.  1 97 

Dr.  Peaslee  has  made  a  calculation  based 
on  the  known  law  of  the  length  of  life  of  a 
woman  who  has  an  ovarian  tumor  uninterfered 
with,  and  the  average  age  of  all  the  recorded 
cases  of  ovariotomy  up  to  1870,  and  the  proba- 
bilities of  longevity  of  healthy  women  of  that 
age  according  to  the  most  approved  tables  of 
life  insurance,  and  has  shown  that  in  the 
"  United  States  and  Great  Britain  ovariotomy 
has,  within  the  last  thirty  years,  directly  con- 
tributed more  than  thirty  thousand  years  of 
active  life  to  woman,  all  of  which  would  have 
been  lost,  had  ovariotomy  never  been  per- 
formed"— to  say  nothing  of  saving  her  more 
than  a  thousand  years  of  untold  suffering. 

With  these  facts  before  us,  most  devoutly 
indeed  should  all  women  bless  the  name  of 
Ephraim  McDowell. 

To  one  living  in  Athens  in  the  days  of  the 
glory  of  ancient  Greece  and  conferring  such  a 
boon  on  the  human  race  as  ovariotomy,  rank 
among  the  demigods,  with  a  temple  and  an 
altar,  would  have  been  accorded  by  acclama- 
tion of  the  people. 

Had  he  lived  in  the  palmy  days  of  the  Roman 
Republic,  the  highest  civic  honors,  a  medal, 
and  a  statue,   if  not  a   shrine    in  the  temple, 


I  g  8  SKE  TCH  B  V  DR.  JOHN  D.  J  A  CKSON. 

would  have  been  his  by  a  decree  of  the  Senate  \ 
and  had  fephraim  McDowell  been  born  and 
had  he  flourished  in  any  one  of  the  principalities 
of  Europe  instead  of  the  United '  States,  long 
since  would  the  government,  proud  of  such  a 
son,  have  conferred  titles  of  distinction  upon 
him  and  his  children  while  living,  and  erected  a 
fitting  monument  to  his  memory  when  dead. 

But  it  seems  that  to  us,  of  the  boasted  Great 
Republic  of  the  Western  World,  the  prover- 
bial charge  regarding  the  ingratitude  of  repub- 
lics is  literally  applicable  in  the  case  of  the  sub- 
ject of  our  sketch. 

Such  were  the  thoughts  which  crowded  upon 
us  when  recently  we  made  a  pilgrimage  to  the 
burial  ground  of  the  Shelby  family  at  "Travel- 
lers' Rest,"  and  after  climbing  the  stone-wall 
enclosure  finally  succeeded  in  making  our  way 
through  brambles  and  wild  flowers  to  a  lichen- 
covered  sandstone  slab  which  simply  bore 
the  name  of  Ephraim  McDowell,  and  which 
covers  the  remains  of  one  to  whom  the  whole 
world  should  feel  deeply  grateful,  and  of  whom 
Kentucky  and  the  American  Republic  may 
always  be  justly  proud. 

While  Kentucky  and  nearly  every  State  of 
the    Republic    has,    at    different    times,    voted 


SKE  TCH  B  Y  DR.  JOHN  D.  J  A  CKSON.  i  gg 

monuments,  statues,  or  paintings  to  one  and 
another  political  favorite,  or  military  idol  of  the 
day,  the  worthiness  of  the  commemoration  of 
none  of  whom  is  to  be  compared  to  that  of 
McDowell ;  and  while  if  our  State  (Kentucky) 
should  erect  the  tallest  shaft  in  all  the  land  to 
mark  his  resting-place  she  would  but  justly 
honor  the  worthiest  of  all  her  children  ;  yet  does 
his  fame  not  rest  with  us  alone,  nor  is  the  benefi- 
cence of  ovariotomy  confined  alone  to  our  part 
of  the  globe.  Like  Jenner,  McDowell  has 
been  a  benefactor  for  the  generations  of  all 
time  and  all  countries,  and  as  a  few  years  ago 
the  world  at  large  contributed  to  the  statue  of 
the  former,  now  erected  in  Hyde  Park,  London, 
so  do  we  think  it  most  fitting  that  all  nations 
should  be  allowed  to  contribute  to  a  suitable 
statue  to  Ephraim  McDowell,  to  be  erected  at 
Danville,  the  scene  of  the  first  ovariotomy. 

But  since  Dr.  McDowell  has  been  woman's 
special  benefactor,  we  think  it  would  be  emi- 
nently appropriate  that  the  gratitude  of  this 
sex  of  all  nations  should  be  allowed  to  dis- 
play itself  in  the  erection  of  a  fitting  memorial 
to  its  friend.  Indeed,  that  a  bronze  statue  of 
life  size  should  be  erected  solely  from  voluntary 
contributions  made  by  those  women  throughout 


2oo  SKE  TCH  B  Y  DR-  JOHN  D.  J  A  CKSON. 

the  world  who  owe  their  lives  to  the  opera- 
tion of  ovariotomy.  The  following  inscription 
might  be  placed  upon  the  memorial  rock : 

Many  women  throughout  the 
world  who,  by  ovariotomy,  have 

been  rescued  from  otherwise 

inevitable  death,  have,  by  their 

combined  contributions, 

erected  this  statue  in  grateful 

commemoration  of 

Dr.  Ephraim  McDowell, 
who,  A.  D.  1809, 

first  removed  an  ovarian 
tumor  and  established  the 

Operation  of  Ovariotomy. 

Ephraim  McDowell,  M.D. 


CHAPTER    XII. 

SKETCH  BY  W.  W.  DAWSON,  M.D. 
EXCERPT  FROM  ADDRESS  BY  RICHARD  J.  LEVIS,  M.D. 

In  an  address  delivered  before  the  Ameri- 
can Medical  Association,  at  Newport,  R.  I., 
in  1889,  by  W.  W.  Dawson,  M.D.,  then  Presi- 
dent of  the  Association,  and  one  of  the  most 
prominent  and  successful  surgeons  of  America, 
occurs  the  following : 

"A  brief  review  of  medical  teaching  in  this 
country  will  be  pardoned — it  may  be  profitable 
— it  will  certainly  illume  the  present,  and  may 
be  somewhat  of  interest  to  the  future. 

"The  first  medical  lectures  were  delivered  by 
Dr.  John  Morgan  and  William  Shippen  in  1767, 
in  Philadelphia.  Dr.  Rush  and  Dr.  Physick 
soon  after  participated,  and  in  1768  the  Medical 
Department  of  the  University  of  Pennsylvania 
was  organized ;  that  great  school  which  is 
steadily  advancing  to  the  highest  station. 

"Philadelphia  was  a  small,  a  provincial,  city  at 
that  time  ;  now  she  is  only  second  to  the  great 

metropolis  in  numerical   strength,  but  second 

(201 ) 


202  SKETCH  BY  DR.    W.    W.  DAWSON. 

to    none    in   the    thorough    equipment   of  her 
medical  schools. 

"  Contemporaneous  with  Philadelphia  an  or- 
ganization was  projected  for  medical  instruc- 
tion in  New  York. 

"In  1767  the  first  steps  were  taken  which 
resulted  in  the  school  ever  since  known  as  the 
'College  of  Physicians  and  Surgeons,'  one 
which  challenges  the  confidence  of  all. 

"  The  medical  colleges  of  New  York,  en- 
dowed not  by  government  but  by  her  public- 
spirited  citizens,  have  won  the  honors  which 
they  wear  so  well. 

"In  1785  the  first  school  was  organized  in 
Boston.  The  chairs  were  four,  and  the  ses- 
sions four  months.  Harvard  is  the  outgrowth 
of  this  humble  beginning  of  that  provincial 
faculty. 

"In  1800  the  first  medical  instruction  was 
given  in  Baltimore  ;  since  then  the  schools  of 
Maryland  have  occupied  a  deservedly  high  posi- 
tion. Recently  one  of  her  citizens  made  an 
endowment  by  which  the  'Johns  Hopkins 
University'  will  be  equipped  for  the  most 
thorough  work,  experimental  work,  laboratory 
studies,  a  range  and  grade  of  investigation  en 
rapport  with  the  spirit  of  the  times.     This  great 


SKETCH  BY  DR.    W.    W.  DAWSON.  203 

benefactor  has  also  given  to  Baltimore  one  of 
the  most  completely  endowed  hospitals  to  be 
found  on  this  earth. 

"  The  great  Mississippi  valley  was  yet  un- 
known, but  soon  after  the  close  of  the  Revolu- 
tion emigration  began,  and  as  early  as  1799 
Dr.  Samuel  Brown  organized  the  medical 
department  of  Transylvania  University. 

"Dr.  Benjamin  Dudley  effected  a  re-organiza- 
tion in  1 8 19. 

"This  school,  after  many  prosperous  years, 
having  graduated  men  who  acquired  distinc- 
tion at  home  and  abroad,  was  transferred,  or 
rather  most  of  the  faculty  removed,  to  Louis- 
ville, when  and  where  the  University  of  Louis- 
ville was  founded. 

"  During  the  early  part  of  the  century  medi- 
cal schools  were  organized  in  several  of  the 
Eastern  States,  usually  under  State  or  church 
patronage.  Most  of  them  exist  to-day.  Some 
of  the  most  distinguished  men  in  our  profession 
have  been  associated  with  these  institutions. 

"As  the  West  and  South  were  peopled, 
medical  schools  were  established  in  cities  and 
promising  towns.  As  early  as  18 19  Dr. 
Daniel  Drake  secured  the  charter  of  the 
Medical   College   of  Ohio,   and   had   it   legally 


204  SKETCH  BY  DR.    W.    W.  DAWSON. 

connected  with  the  City  Hospital.  The  faculty 
constituted  the  hospital  staff,  the  members  of 
which  were  required  to  give  clinical  lectures — 
the  first  forward  step  on  the  continent  in  blend- 
ing didactic  with  clinical  instruction. 

"The  physicians  in  South  Carolina  began 
medical  teaching  in  1823,  and  those  of  Louisi- 
ana in  1835.  In  both  of  these  States  schools 
of  high  character  have  been  maintained." 

Dr.  Dawson  further  said:  "The  advance  in 
medical  education  is  a  gain  most  distinctly  pro- 
nounced by  a  remark  made  by  one  of  our  dis- 
tinguished fellows,  an  American-bred  physician, 
of  whose  fame  we  are  all  justly  proud. 

"In  conversation  Dr.  Battey  said:  'When 
I  began  practice  thirty  years  ago  there  was 
scarcely  a  graduate  within  fifty  miles  of  my 
residence ;  now,  however,  there  is  hardly  a 
practitioner  in  the  same  territory  who  is  not  a 
graduate,  and  year  after  year  a  portion  of  our 
young  men  leave  home  to  avail  themselves  of 
clinical  advantages  to  attend  post-graduate 
instruction.' 

"  Could  anything  show  more  forcibly  the  con- 
servative and  steady  growth  of  medical  culture  ? 

"  In  our  own  country,  as  well  as  elsewhere, 
great  achievements  have  often  been  made  in 


SKETCH  BY  DR.    W.    W.  DAWSON. 


205 


the  provinces  and  not  always  under  the  shadow 
of  the  universities. 

"  One  of  the  greatest  operations1  waited  for 
years  for  a  metropolitan  disciple — one  to  take 
it  up  ;  and  that  too,  long  after  the  provinces  at 
home  and  abroad  had  demonstrated  its  vital 
utility,  its  claim  upon  the  scientific  and  skilful 
surgeon. 

"  Some  of  the  classical  schools  of  Oxford  and 
Cambridge  were  organized  as  early  as  the 
thirteenth  century,  but  the  systematic  scientific 
study  of  medicine  and  surgery  came  long  sub- 
sequently, not  for  four  hundred  years  later — 
about  the  middle  of  the  eighteenth  century. 

"  It  was  first  projected  in  Great  Britain,  and 
soon  after  in  our  Atlantic  cities.  Unlike  the 
old  world,  our  fathers  had  a  wilderness  to  con- 
quer before  progress  could  be  made. 

"  When  the  pilgrim  fathers  left  England,  read- 
ing and  writing  were  rare  accomplishments, 
chimneys  in  that  country  had  just  been  in- 
vented, and  flock  beds  were  luxuries. 

"The  adventurers — the  emigrants  to  these 
shores  from  that  ancient  and  imperfect  civiliza- 
tion— had  much  to  learn,  but  in  the  midst  of 
their  pitiable  ignorance,  facing  great  hardships 

1  Ovariotomy. 


206  SKETCH  BY  DR.    W.    W.  DAWSON. 

and  pressing  wants,  they  were  quick  to  pro- 
vide educational  opportunities  for  all. 

"The  results  of  their  efforts  are  apparent — 
they  are  before  us.  Could  more  have  been 
accomplished  in  one  century? 

"Had  Sidney  Smith  been  a  physician  and 
given  to  reading,  he  would  not,  even  in  1850, 
have  asked  the  questions :  Who  reads  an 
American  book?  What  does  the  world  owe 
to  American  physicians  and  surgeons  ?  This 
reverend  gentleman,  this  famous  critic,  could 
not  have  heard  of  Ephraim  McDowell,  whose 
brief  paper,  detailing  his  first  three  cases  of 
ovariotomy,  published  in  the  Philadelphia  Eclec- 
tic Repertory,  in  18 17,  was  of  more  value,  did 
more  for  the  conservation  of  human  life  than  a 
score  of  ordinary  publications. 

"Our  first  half  century  may  be  poor  in  books, 
but  it  abounded  in  strong,  devoted,  conscien- 
tious, and  brave  men,  men  who  with  the  most 
limited  resources  accomplished  the  grandest 
results. 

"They  compelled  success,  because  they  de- 
served it.  The  ink  was  hardly  dry  upon  that 
cynical  pen  when  anaesthesia  was  presented  by 
the  profession,  so  poor,  as  he  supposed,  in 
valuable  works. 


SKETCH  BY  DR.    W.    W.  DAWSON.  20? 

"But  what  country  or  age  can  match  in  great 
contributions  to  the  relief  of  the  suffering, 
McDowell,  Sims,  Bigelow,  Sayre,  Battey,  and 
Emmet,  and  that  trinity  of  men,  Wells,  Mor- 
ton, and  Jackson,  who  gave  anaesthesia  to  the 
world.  The  heart  of  every  American  physician 
is  filled  with  thankfulness  when  he  remembers 
that  in  the  providence  of  God  this  great  boon 
to  humanity  was  vouchsafed  to  this  country. 
The  very  ground  upon  which  stands  the  Massa- 
chusetts General  Hospital  is  sacred  to  us  all. 

"Associated  with  the  discoverers  must  ever 
be  the  name  of  Dr.  Hayward,  who  performed 
the  first  operation  under  the  strange  Letheon. 
Previous  to  this,  operative  surgery  was  slow, 
tedious,  and  almost  cruel.  Contrast  it  to-day 
with  what  it  was  previous  to  1847,  what  grand 
strides  it  has  made  under  the  direct  support  of 
anaesthesia,  and  its  almost  equal  co-laborer 
antisepsis.  The  great  cavities  are  invaded,  and 
invaded  safely  ;  the  abdomen  has  become  a 
familiar  field. 

"The  story  of  Ephraim  McDowell,  though  so 
often  repeated,  humanity  never  tires  of  hearing. 

"To  us  he  belongs,  and  to  us  only ;  we  can- 
not share  his  fame  with  another,  we  would  not 
if  we  could.     Who  can  measure  the  relief  which 


2o8  ADDRESS  B  Y  DR.  R.  J.  LEVIS. 

his  operation  has  bestowed  upon  suffering 
woman  ? — not  only  woman,  for  his  was  the 
genius  which  opened  the  way  to  laparotomy  in 
both  sexes." 

Dr.  Richard  J.  Levis,  in  an  address  at  the 
thirty-ninth  annual  session  of  the  Medical 
Society  of  the  State  of  Pennsylvania,  alluded 
to  Dr.  McDowell  as  follows  : 

"  The  records  of  the  experience  of  individual 
practitioners  of  intelligent  and  trained  minds 
would  be  a  gain  to  surgical  progress,  and  tend 
to  avoid  the  transmission  of  traditional  errors. 

"  From  practitioners  in  regions  far  away  from 
medical  centres,  in  such  locations  as  are  abroad 
styled  provincial,  have  originated  some  of  the 
most  valuable  practical  discoveries  and  ad- 
vances. 

"There  may  be  instanced  the  discovery  of 
vaccination  in  rural  England,  by  Jenner ;  the 
origin  of  ovariotomy  by  McDowell,  in  what  was 
then  a  frontier  region  of  Kentucky  ;  and  the 
very  beginning  of  practical  gynecology,  by 
Marion  Sims,  in  the  obscurity  of  Northern 
Alabama. 

"It  is  said  that  the  ploughman,  tilling  the 
fields  of  the  western  slope  of  our  continent, 
who  keeps  his  eyes  intently  on  the  furrow,  may 


SKETCH  BY  DR.    W.    W.DAWSON.  2O9 

occasionally  find  nuggets  of  gold ;  and  so  the 
faithful  toiler  amidst  human  ills  is  liable  to 
unearth  jewels  of  fact,  which,  garnered  and 
recorded,  will  add  to  the  wealth  of  surgical 
knowledge." 
14 


CHAPTER   XIII. 

DESCRIPTION    OF    ONE    OF    THE    METHODS    OF 
PERFORMING    OVARIOTOMY. 

Dr.  John  H.  McIntyre,  of  St.  Louis,  Mo., 
a  very  successful  ovariotomist,  has,  by  request, 
kindly  furnished  us  with  a  detailed  account  of 
the  present  mode  of  doing  the  operation  of 
ovariotomy,  in  order  that  the  reader  may  be 
able  to  contrast  the  performance  of  these 
times  with  that  of  its  first  accomplishment  in 
the  history  of  the  medical  world,  by  Ephraim 
McDowell,  eighty  years  ago.  The  abdominal 
cavity  was  up  to  that  time,  unexplored  ;  and  as 
a  very  prominent  and  successful  practitioner  of 
Chicago,  Illinois,  crudely  said  :  "  McDowell  cut 
away  the  abdominal  barriers,  and  the  surgeons 
walked  in  and  reaped  the  harvest  of  his  daring 
surgical  adventure."  So  long  as  Dr.  McDowell 
lived,  it  certainly  was  his  earnest  desire  that  the 
operation  ovariotomy  s/iou/d  not  be  abused 
by  the  medical  profession.;  as  the  reader  will 

(2IO) 


OVARIOTOMY.  211 

perceive  in  his  (Dr.  McDowell's)  reply  to  criti- 
cisms published  in  vindication  of  the  opera- 
tion. Hence  he  urged  surgeons  to  be  guarded, 
and  not  abuse  it  in  a  reckless  way  ;  that,  with 
judicious  caution,  ovariotomy  would  prove 
woman's  benefactor,  but  abused,  her  curse. 

Dr.  Mclntyre  says  : 

I  may  remark  that  it  gives  me  pleasure  to 
speak  of  the  present  status  of  this  operation 
as  compared  to  the  opposition  which  it  met 
in  its  earlier  days,  as  it  is  to-day  one  of  the 
most  successful  and  brilliant  of  any  of  the  major 
operations,  adding  thousands  of  years  to  the 
life  of  woman  ;  and  smiles  and  happiness  to 
households  which  would  have  been  left  gloomy 
and  desolate  by  the  loss  of  her  who  was  its 
centre  and  its  sunshine.  For  many  years  the 
opposition  to  this  operation  was  most  bitter  and 
revengeful.  Gentlemen  occupying  high  posi- 
tions in  the  profession  stigmatized  it  in  most 
unmeasured  terms.  Well  do  I  remember  the 
denunciations  hurled  upon  its  justifiableness  by 
the  elder  Meigs,  in  a  lecture  before  a  class  of 
the  Jefferson  Medical  College  of  Philadelphia ; 
and,  student  as  I  was  at  that  time,  I  saw  that 
his  judgment  was  biassed,  and  I  resolved  then 
and  there,  that  when  the  proper  time  arrived  / 


212  OVA  RIO  TO  MY. 

would  do  the  operation.  In  a  review  of  Mr. 
Clay's  work  in  the  British  and  Foreign  Medical 
Review,  of  1843,  vol.  xvi.  p.  402,  this  passage 
is  found:  "To  our  thinking,  the  facts  need  no 
comment.  We  earnestly  hope  that  they  will 
prevent  the  younger  members  of  the  profession 
from  being  dazzled  by  the  alleged  success  of 
this  operation."  A  fundamental  principle  of 
medical  morality  which  we  conceive  is  outraged 
whenever  an  operation,  so  fearful  in  its  nature, 
often  so  immediately  fatal  in  its  results  as  gas- 
trotomy,  is  performed  for  the  removal  of  a  dis- 
ease, of  the  very  existence  of  which  the  sur- 
geon is  not  always  sure  ;  of  the  curability  of 
which,  by  his  interference,  he  must  be  in  the 
highest  degree  uncertain. 

At  a  meeting  of  the  Royal  Medico-Chirur- 
gical  Society  (England),  November  12,  1850, 
no  less  a  man  than  Lawrence  said:  "I  have  no 
experience  of  ovariotomy.  I  have  not  per- 
formed it,  and  unless  my  view  of  the  matter 
should  be  essentially  altered,  I  never  shall." 
And  he  further  asked  the  question,  "Can  this 
operation  be  encouraged,  and  continued  with- 
out danger  to  the  character  of  the  profession?" 
In  one  of  my  conversations  with  Keith  (then 
of  Edinburgh),  in   1879,  while    complimenting 


OVARIOTOMY.  213 

him  on  the  brilliant  results  of  his  work,  and  the 
esteem  and  admiration  in  which  he  was  held  by 
the  profession  in  America,  he  replied  :  "It  was 
not  always  so  pleasant.  Not  long  after  I 
began  to  do  ovariotomies,  one  of  the  heads  of 
the  profession  here — one  of  the  best  and  most 
honest  of  men — indeed,  he  was  my  old  teacher, 
and  one  to  whom  I  looked  up  to  as  my  profes- 
sional father — said  to  me  :  '  Fellows  like  you 
should  simply  be  handed  over  to  Mr.  Lothian.' 
Now  Mr.  Lothian  was  the  public  prosecutor, 
and  you  can  easily  see  what  that  meant." 

In  contradistinction  to  the  above,  a  few  years 
later,  Sir  James  Paget  stated  :  "  This  operation 
is  one  of  the  greatest  achievements  of  surgery 
in  this  century,  and  the  gain  is  not  limited  to 
ovariotomy  alone  ;  the  success  of  this  operation 
has  led  to  an  extension  of  the  whole  domain  of 
peritoneal  surgery.  Surgeons  act  more  boldly 
than  before  in  operations  involving  the  perito- 
neum, and  the  influence  for  good  is  not  limited 
by  the  increased  success  of  ovariotomy,  but 
extends  through  many  departments  of  opera- 
tive surgery,  and  will  always  continue  to  be 
felt  in  the  whole  practice  of  surgery." 

Peaslee,  in  the  beginning  of  1873,  asserts 
that  it  may  be  shown  that  in  the  United  States 


214  OVARIOTOMY. 

and  Great  Britain  alone,  ovariotomy  has,  within 
the  last  twenty  years,  directly  contributed  more 
than  thirty  thousand  years  of  active  life  to 
woman  ;  all  of  which  would  have  been  lost  had 
ovariotomy  never  been  performed.  His  calcu- 
lations by  which  he  arrives  at  these  results  are 
quite  elaborate,  and  are  no  doubt  correct.  It 
will  be  observed  that  his  statement  was  made 
fifteen  years  ago,  and  it  applied  only  to  Great 
Britain  and  the  United  States.  Since  that  time 
this  operation  has  extended  all  over  the  civil- 
ized world :  and  it  would  be  a  difficult  matter 
to  compute  the  many  thousands  of  years  vouch- 
safed to  woman  by  this  operation.  In  one  of 
the  earlier  editions  of  Diseases  of  Women,  Dr 
West  thus  writes  •  "  I  think,  then,  that  we  are 
now  bound  to  admit  'ovariotomy'  as  one  of 
the  legitimate  operations  in  surgery  ;  as  hold- 
ing out  a  prospect,  and  a  daily  brightening 
prospect  of  escape  from  a  painful  and  inevitable 
death,  which  at  last,  indeed,  becomes  welcome, 
only  because  the  road  that  leads  to  it  conducts 
the  patient  through  such  utter  misery." 

Lord  Selborne,  one  of  the  most  distinguished 
of  the  British  Chancellors,  speaking  at  the 
opening  of  the  Dorset  House  Branch  of  the 
Samaritan  Hospital  for  Women  in   1875,  said, 


OVARIOTOMY. 


215 


"The  work  done  by  the  hospital  he  regarded 
not  only  with  satisfaction  but  with  admiration, 
for  it  represented  one  of  the  most  splendid 
triumphs  of  modern  surgical  art  and  modern 
philanthropy,  one  of  the  greatest  achievements 
of  medicine  or  of  surgery  in  any  age.  Until  a 
few  years  since,  this  kind  of  disorder  had  been 
regarded  as  necessarily  and  absolutely  fatal, 
and  as  reducing  the  reasonable  possibility  of 
life  in  the  woman  afflicted  by  it  to  four  years, 
though  the  duration  of  life  generally  fell  far 
short  of  that.  Instead  of  the  four  years  of 
declining  health  and  hopeless,  misery  which 
those  women  would  have  had  to  anticipate,  not 
only  those  four  years,  but  twenty-five  years, 
which,  upon  the  average,  had  been  wholly 
saved  to  them,  were  years  of  restored  health, 
usefulness,  and  happiness  to  those  who  had 
been  benefited  by  the  operation.  He  thought 
the  man  of  whom  that  could  be  said,  and  the 
art  of  which  it  could  be  said,  deserved  higher 
honors,  higher  reward,  and  higher  praise  than 
most  things  which  it  was  permitted  to  any  man 
or  any  art  in  this  world  to  be  able  to  do." 

If  there  was  ever  a  public  benefactor,  surely 
it  was  your  illustrious  grandsire,  Ephraim 
McDowell,  who,  on  that  cold  December  morn- 


2 1 6  O  VARIO  TOM  Y. 

ing,  in  the  year  1809,  on  the  person  of  Mrs. 
Crawford,  who  must  have  been  necessarily 
fatigued  by  a  journey  of  sixty  miles  on  horse- 
back, with  the  protuberant  abdomen  bruised 
by  contact  with  the  horn  of  the  saddle,  gave  to 
the  world  and  to  mankind,  by  his  courage  and 
his  skill,  this  brilliant  and  beneficent  operation. 
It  was  the  dawn  of  a  new  era  in  surgery,  and 
its  beneficence  is  not  confined  to  ovariotomy 
alone.  But  for  its  successful  inauguration, 
would  Simon,  of  Heidelberg,  in  1869,  have  ever 
dared  to  extirpate  the  kidney  on  a  living  sub- 
ject? Would  Billroth,  of  Vienna,  have  had 
the  courage,  with  all  his  dash  and  brilliancy  as 
an  operator,  to  exsect  the  human  stomach  for 
cancer  ?  Would  laparotomy  for  the  control  of 
hemorrhage  and  the  closing  of  wounds  in  the 
intestines  occasioned  by  leaden  missiles  be  a 
recognized  and  legitimate  operation  of  the  day? 
Would  not  those  unfortunates  suffering  from 
uterine  fibroids  be  abandoned  to  their  fate  ?  and 
would  not  our  own  Battey  have  hesitated  ere 
he  performed  the  operation  which  bears  his 
name,  had  not  the  immortal  McDowell  pre- 
ceded him  in  a  hitherto  unknown  field  ? 

But  to  proceed  to  the  operation:  and  here 
allow  me   to  remark,   that  couragfe  and   confi- 


OVARIOTOMY.  217 

dence  on  the  part  of  the  patient  are  impor- 
tant elements  of  success.  The  most  favorable 
view  of  her  case,  consistent  with  truth  and 
veracity,  should  be  presented  to  her,  and  every 
proper  means  taken  to  help  her  to  expect  re- 
covery, instead  of  leaving  her  mind  in  doubt 
and  uncertainty.  Preparatory  measures  should 
be  instituted  to  secure  a  healthy  action  of  the 
liver,  kidneys,  and  skin.  To  this  end  the  bowels 
should  be  emptied  of  all  accumulations  by  gen- 
tle cathartics,  the  renal  organs  increased  in 
activity  by  the  administration  of  proper  diu- 
retics, and  the  cutaneous  organs  stimulated  by 
hot  baths,  followed  by  friction  over  the  surface 
of  the  body.  Sleep  should  be  induced  by  the 
administration  of  the  bromide  of  potassium  or 
of  chloral  hydrate,  and  on  the  morning  of  the 
operation  the  intestines  should  be  opened  thor- 
oughly by  a  large  enema  of  hot  water,  in  which 
one  or  two  tablespoonfuls  of  salt  have  been  dis- 
solved. A  bright,  clear  day  is  preferable,  but 
when  the  operation  has  been  fixed  for  a  certain 
hour  (I  prefer  to  operate  at  1 1  a.m.)  it  should 
not  be  postponed  on  account  of  bad  weather. 
The  best  place  for  the  operation  is  at  the  home 
of  the  patient,  provided  quiet  and  cleanliness 
and  good  ventilation  can  be  obtained.     Private 


2 1 8  OVA  RIO  TOMY. 

hospitals,  where  good  attention  is  always  at 
hand,  is  the  next  best  place,  and  perhaps 
equally  as  good  as  the  home  of  the  patient. 
A  large  general  hospital  is  the  last  place  / 
would  select  in  which  to  do  an  ovariotomy. 
The  dress  of  the  patient  at  the  time  of  the 
operation  should  consist  of  woollen  underwear, 
drawers  and  stockings,  together  with  a  muslin 
nightgown,  and  during  the  operation  as  little  of 
the  surface  of  the  body  as  possible  should  be 
uncovered ;  the  additional  precaution  being 
taken  to  wrap  the  lower  extremities  in  a  wool- 
len blanket.  The  operating  table  should  be 
five  feet  long,  and  twenty  inches  wide,  and 
high  enough  to  enable  the  operator  to 
stand  erect;  it  should  be  placed  near  a 
large  window,  and  yet  so  that  all  may  pass 
around  it  with  ease.  It  should  be  covered 
with  two  or  three  comfortables,  over  which  are 
spread  a  clean  muslin  sheet  and  a  rubber  or  oil 
cloth.  The  personal  preparation  of  the  sur- 
geon, his  assistants  and  the  attendants,  is  a 
matter  of  paramount  importance  ;  perfect  clean- 
liness, which  is  next  to  godliness,  should  be 
rigidly  insisted  upon.  On  the  day  of  the  opera- 
tion they  should  not  be  engaged  in  dressing 
wounds  or  in  attending  any  infectious  disease. 


OVARIOTOMY.  219 

Their  clothing  should  be  scrupulously  clean, 
their  hands  should  be  washed  in  carbolized 
water,  and  the  finger-nails  carefully  cleaned. 
And  here  it  is  proper  to  remark,  that  on  no 
account  should  an  assistant,  during  the  opera- 
tion, be  permitted  to  place  his  hand  in  the 
abdomen  of  the  patient,  except  on  invitation  of 
the  chief  operator.  Everything  being  in  readi- 
ness the  patient  should  be  thoroughly  anaesthe- 
tized, and  while  this  can  be  accomplished  by 
ether  or  chloroform,  yet  I  am  an  enthusiastic 
advocate  of  bichloride  of  methylene,  adminis- 
tered in  a  Junker's  inhaler,  not  only  in  all  my 
ovariotomies,  but  in  many  other  grave  opera- 
tions. I  was  led  to  its  use  by  seeing  with  what 
ease  and  safety  anaesthesia  was  induced  and 
maintained  by  it  in  the  Free  Samaritan  Hos- 
pital, in  London,  and  also  in  some  of  the  pri- 
vate operations  of  Sir  Spencer  Wells,  who,  in 
1877,  said,  "that  after  ten  years'  experience  of 
its  use,  in  more  than  one  thousand  cases,  he 
believed  it  to  be,  without  a  single  exception, 
applicable  to  every  patient,  perfectly  certain  to 
produce  complete  anaesthesia,  relieving  the 
surgeon  from  all  alarm  and  even  anxiety,  and 
its  use  has  never  been  followed  by  any  danger- 
ous symptoms  which  could  be  fairly  attributed 


220  °  VARIO  TOMY. 

to  it."  I  have  now  used  it  in  over  two  hun- 
dred operations  of  various  kinds,  and  my  ex- 
perience tallies  with  the  above  in  every  par- 
ticular, and  I  have  yet  to  meet  with  a  single 
untoward  symptom  arising  from  it.  After  the 
patient  has  been  anaesthetized  she  should  be 
placed  on  the  operating  table,  with  her  feet 
toward  the  light,  her  wrapper  drawn  up  under 
her  arms,  and  the  abdomen  covered  with  a 
light  rubber  blanket,  having  an  opening  eight 
or  ten  inches  in  length,  and  of  sufficient  width 
to  permit  an  easy  exposure  of  the  most  promi- 
nent part  of  the  abdomen.  The  surgeon  takes 
position  on  the  right  side  of  the  patient,  and 
places  his  first  assistant  immediately  opposite. 
The  instruments  should  be  within  easy  reach, 
and  be  placed  in  a  shallow  earthenware  dish 
(that  used  by  photographers  is  the  best)  con- 
taining a  i  :  40  carbolic  acid  solution,  and  be 
arranged  as  nearly  as  possible  in  the  order  in 
which  they  are  likely  to  be  required.  The 
operation  may  be  divided  into  three  stages : 
1.  The  exposure  of  the  tumor.  2.  Its  re- 
moval. 3.  Cleansing  the  peritoneal  cavity, 
"toilet  of  the  peritoneum,"  and  closure  of 
the  ventral  wound.  To  accomplish  this  the 
following  instruments  will  be  needed  :  one  seal- 


OVARIOTOMY. 


221 


pel,  one  straight  probe-pointed  bistoury,  one 
tenaculum,  one  Keyes's  director,  one  pair  dis- 
secting forceps,  one  artery  forceps,  one  dozen 
pairs  bow-torsion  forceps,  one  No.  10  steel 
sound,  one  Sir  Spencer  Wells's  omentum 
clamp,  two  pairs  vulsella,  two  pairs  Nelaton's 
forceps,  one  Wells's  needle-holder,  one  cautery 
clamp,  one  sponge-holder,  twelve  veterinary 
needles,  straight  and  curved ;  besides  at  least 
twelve  soft  cup  sponges,  three  spools  of  Jap- 
anese cable  silk,  Nos.  i,  2,  and  3  ;  silkworm 
gut ;  one  broad  flat  potter's  sponge  ;  and  it  is 
also  well  to  have  a  Paquelin's  thermo-battery 
at  hand  for  charring  the  pedicle. 

The  incision  should  be  made  exactly  in  the 
median  line,  midway  between  the  symphysis 
pubis  and  the  umbilicus ;  in  doing  this  we  may 
cut  freely  through  the  skin  and  adipose  tissue 
immediately  beneath  it,  which  will  expose  the 
aponeurotic  expansion  of  the  abdominal  mus- 
cles. Now,  with  the  tenaculum,  lift  up  a  thin 
layer  of  this  aponeurosis,  and  divide  it  on  the 
Keyes's  director.  If  we  are  not  exactly  in  the 
median  line,  the  edge  of  the  rectus  muscle  will 
come  into  view  ;  should  this  be  the  case,  the 
linea  alba  may  be  found  by  passing  the  handle 
of  the  scalpel  first  to  one  side  and  then  to  the 


222  0VA  RI°  T0M  v- 

other,  when  the  edge  of  the  muscle  will  be 
encountered.  By  very  light  strokes  with  the 
knife  we  divide  the  tissues  until  we  come  down 
upon  the  thin  and  loose  cellulo-adipose  tissue 
which  lies  just  external  to  the  peritoneum. 
Bleeding  should  be  controlled  by  the  applica- 
tion of  a  bow-torsion  forceps  to  every  point 
which  requires  it.  After  all  hemorrhage  has 
ceased,  the  peritoneum  should  be  raised  on  the 
point  of  the  tenaculum,  and  divided  to  such  an 
extent  as  will  admit  of  the  introduction  of  the 
Keyes's  director  upon  which  it  is  to  be  divided 
the  extent  of  the  incision.  The  steel  sound 
should  now  be  introduced  between  the  sac  and 
the  abdominal  walls,  and  swept  around  slowly 
and  gently,  to  detect  the  presence  or  absence 
of  adhesion  over  the  anterior  portion  of  the 
tumor.  If  no  adhesions  are  found,  the  large 
Wells's  trocar,  with  the  rubber  hose  attached, 
should  now  be  plunged  into  the  sac  at  the 
upper  angle  of  the  wound,  and  the  fluid  allowed 
to  flow  through  the  tubing  into  the  vessel  placed 
for  its  reception  under  the  table.  As  the 
tumor  decreases  in  size,  the  sac  should  be 
seized  with  the  vulsellum  or  Nekton's  forceps, 
or  both,  and  drawn  forward  on  the  canula,  to 
prevent  the  fluid  from   entering  the  cavity  of 


OVARIOTOMY.  22X 

the  abdomen.     This  part  of  the  operation  may 
be  much  facilitated  by  judicious  pressure  upon 
the  abdominal  walls  by  the  hands  of  one  of  the 
assistants.     If  the   sac   is  unilocular  it  can   be 
entirely   emptied   through    a    single    puncture. 
If  the  sac  is  multilocular  the  trocar  should  be 
passed  from  the  primary  puncture  of  the  main 
cyst   into    each    presenting   cyst   successively, 
until  all  are  emptied  and  the  tumor  be  reduced 
to  such  size  that  it  can  be  brought  out  through 
the  incision.     If  the  contents  of  the  sac  are  so 
viscid  or  solid  as  not  to  be  able  to  pass  through 
the  canula,  a  large  opening  must  be  made  in 
the  sac,  and  the  hand  introduced  as  a  scoop  to 
remove  them.     The  cyst  is  then  drawn  through 
the  opening  and  brought  through  the  outside 
of   the  body,   which  exposes  the  pedicle.     Of 
course,  all  adhesions  must  be  carefully   sepa- 
rated and  all  bleeding  points  ligated.     On  the 
subject  of  securing  the  pedicle,  ovariotomists 
are  not  agreed.     The  most  common  methods 
are  the  clamp,  the  ligature,   the    cautery,  and 
the  ecraseur.     I  prefer  the  ligature  or  the  cau- 
tery.    If  the  ligature  is  used,  the  pedicle  should 
be  transfixed  by  a  large  aneurism  needle,  and 
tied  in  two  or  three  sections,  with  the  Japanese 
cable  silk  ;  the  tumor  cut  away  three-quarters 


224  O  VAR10  TO  MY. 

of  an  inch  from  the  ligature,  and  the  stump 
dropped  back  into  the  abdomen. 

In  using  the  cautery,  the  method  which  I 
greatly  prefer,  the  pedicle  is  tightly  embraced 
in  the  cautery  clamp,  two  small  folded  towels 
wrung  out  of  cold  water  being  placed  under  it, 
next  the  abdomen.  The  tumor  is  then  burned 
off  external  to  the  clamp  and  the  iron  (Pa- 
quelin  thermo-cautery,  I  use)  at  a  dull  red 
or  black  heat,  is  passed  over  the  stump 
slowly  and  steadily  for  several  minutes,  until  it 
is  entirely  charred — "  mummified,"  if  you  please 
so  to  call  it.  The  danger  in  using  the  cautery 
only  consists  in  using  an  ill-constructed  clamp, 
having  the  cautery  iron  at  too  high  a  heat,  and 
the  operator  being  in  too  great  a  hurry. 

The  most  painstaking  care  should  be  exer- 
cised in  the  search  for  bleeding  points,  each  and 
every  one  of  which  should  be  controlled  by  a 
ligature  of  fine  silk.  Blood,  serum,  or  ovarian 
fluid  should  be  carefully  sponged  out  of  the 
cavity  until  it  is  absolutely  dry ;  and  before 
closing  the  external  wound,  the  ligatures  should 
be  cut  short  and  the  uterus  and  the  stump  of 
the  pedicle  be  placed  below  the  intestines  in 
their  normal  position.  In  closing  the  external 
wound,   various  articles  may  be  used,  such  as 


O  VA  RIO  TO  MY.  2  2  r 

silk,  silver  wire,  iron  wire,  etc.  But  in  my 
opinion  silkworm-gut  is  the  ideal  suture.  I  am 
indebted  to  Dr.  George  Granville  Bantock,  of 
London,  for  the  idea  of  its  use.  It  is  hard, 
round,  smooth,  and  unirritating,  and  can  be 
rendered  perfectly  aseptic  by  placing  it  in  the 
solution  the  day  before  it  is  required  for  use. 
It  is  obtained  by  taking  the  cocoons,  about  the 
time  they  are  ready  to  spin,  and  steeping  them 
in  dilute  acetic  acid,  when  they  become  a  soft, 
pulpy  mass  ;  it  is  then  "  drawn"  like  silver  wire. 
In  all  gynecological  operations,  nothing  can 
exceed  this  suture  for  safety,  the  facility  with 
which  it  can  be  introduced,  or  the  ease  and 
slight  disturbance  of  the  line  of  union  in  its 
removal. 

The  "  toilet  of  the  peritoneum  "  being  com- 
plete, the  flat  potter's  sponge  should  be  intro- 
duced into  the  abdomen  immediately  under  the 
ventral  wound  to  absorb  any  blood  which  might 
trickle  down  from  the  punctures  made  by  the 
needle.  Two  veterinary  needles  should  be 
"threaded"  on  a  strand  of  silkworm-gut;  the 
needle  taken  in  the  grasp  of  Spencer  Wells's 
holder,  and  should  be  introduced  from  within 
the  wound,  and  should  pass  through  the  peri- 
toneal, muscular,  and  cutaneous  tissues  ;  the 
15 


226  °  VARIO  TOM  Y. 

needle  is  now  detached,  and  the  end  of  the 
suture  given  into  the  hands  of  an  assistant ;  the 
other  needle  is  next  introduced  and  passed  in 
the  same  manner  upon  the  opposite  side  of  the 
wound,  so  that  the  suture  will  inclose  all  the 
parietal  layers — these  sutures  should  be  placed 
less  than  an  inch  apart,  and  it  is  well  to  require 
every  sponge  and  instrument  which  has  been 
brought  into  the  operating  room  to  be  accounted 
for  before  closing  the  wound.  The  flat  sponge 
should  now  be  removed  and  the  sutures  tied. 

However,  should  it  be  evident  or  probable 
that  oozing  of  blood  or  serum,  or  of  both,  will 
go  on  after  closure  of  the  external  wound,  and 
especially  when  there  has  been  an  escape  of 
ovarian  fluid  into  the  peritoneal  cavity,  drain- 
age will  be  demanded.  This  is  best  accom- 
plished by  the  use  of  the  glass  tube  of  Dr. 
Keith,  now  of  London.  After  introducing  all 
the  sutures,  Douglas's  pouch  is  finally  cleaned 
out,  and  while  with  the  left  hand  the  intestines 
are  kept  out  of  the  way,  the  fingers  serving  as 
a  guide  to  the  tube,  it  is  passed  down  to  the 
bottom  of  the  pouch  between  two  of  the  sutures, 
and  in  such  a  manner  that  the  tube  maintains 
a  perpendicular  position,  after  which  the  suture 
may  be  tied.     A   cup   sponge  wrung  out  of  a 


OVARIOTOMY.  22J 

one  to  twenty  carbolic  acid  solution  should  be 
placed  over  the  external  end  of  the  tube  and 
the  dressing  completed.  The  drainage-tube 
will  seldom  be  needed  longer  than  the  fifth  or 
sixth  day,  but  in  that  time  many  ounces  maybe 
removed  by  the  glass  syringe  over  the  nozzle 
of  which  is  drawn  a  piece  of  rubber  tubing.  In 
the  after-dressing  several  wide  strips  of  adhe- 
sive plaster  should  be  placed  across  the  abdo- 
men, over  a  piece  of  "  protective  "  sufficiently 
large  to  cover  every  part  of  the  wound. 

Over  this  should  be  applied  large  flannel 
compresses  three  or  four  inches  thick,  and  the 
whole  should  be  encased  by  a  broad  flannel 
binder,  extending  from  the  pubes  to  the  ensi- 
form  cartilage ;  after  which  the  patient  may 
be  placed  in  bed,  the  operative  procedure  being 
completed. 


CHAPTER   XIV. 

MCDOWELL'S    OPERATION    OF    OVARIOTOMY    BY    THE 
LONG    INCISION   DURING  THE   FIRST    THIRTY- 
THREE    YEARS   OF    ITS    EMPLOYMENT, 
WITH  COMMENTS. 

By  Nathan  Bozeman,  M.D.,  New  York  City. 


Introduction.1 

In  my  somewhat  extended  title  I  present  at 
once  to  the  reader  a  broad  field  of  study  and 
investigation  upon  seemingly  an  old  subject, 
and  the  question  will  no  doubt  be  as  promptly 
asked,  what  there  is  new  or  profitable  to  be 
learned  from  previously  reported  and  well 
stated  facts  pertaining  to  an  operation  so  thor- 
oughly well  understood  at  the  present  time  as 
that  of  ovariotomy  ?  I  might  answer  this  ques- 
tion by  asking  another  :  Have  all  the  facts  con- 
nected with  the  origin  and  development  of  this 
truly  useful  and  universally  accepted  operation 
ever  been  brought  out  in  the  order  of  their 
chronological    importance  and  significance,   as 

1  Read  before  the  New  York  County  Medical   Association, 
May  19,  1890. 
(228) 


MC  D  O  WEL  L '  S  OPE  J?  A  TIOiY. 


229 


their  merits  have  entitled  them  to  be,  and  the 
claims  of  the  "Father  of  the  Operation"  de- 
manded ? 

But  I  do  not  content  myself  by  simply  an- 
swering a  question  of  justice  or  sentiment,  the 
genuineness  of  the  latter  having  already  been, 
as  it  will  continue  to  be  to  the  end  of  time,  fully 
appreciated  by  mankind.  This  sentiment  is,  as 
yet,  embalmed  in  the  memories  of  his  profes- 
sional brethren  for  scarcely  two  generations, 
and  the  remains  of  Ephraim  McDowell  are  but 
freshly  deposited,  as  it  were,  in  the  tomb  at 
Danville  (the  theatre  of  his  surgical  achieve- 
ments)— a  silent  though  significant  reminder  of 
the  ending  of  a  truly  great  and  useful  life,  and 
the  important  incidents  connected  with  it.  Here 
in  this  beautiful  little  town  of  Kentucky,  near 
the  homes  and  resting-places  of  his  contempo- 
raries, Dudley,  the  greatest  of  lithotomists,  and 
Clay,  the  most  eminent  among  statesmen,  a 
grateful  profession,  which  he  while  living  so 
much  adorned,  has  erected  a  monument  to  the 
memory  of  McDowell,  to  perpetuate  not  only 
his  honored  name,  and  his  noble,  generous,  and 
well-spent  life,  but  the  transcendent  value  and 
acknowledged  influence  of  his  labors  in  benefit- 
ing mankind.      Let  each  succeeding  generation 


230  MCDOWELL'S  OPERATION. 

of  physicians,  therefore,  acknowledge  and  treas- 
ure the  inestimable  advantages  it  has  derived 
from  these  labors. 

My  contribution  in  regard  to  the  acknowl- 
edged and  appreciated  benefits  arising  directly 
from  the  labors  of  McDowell,  the  "Father  of 
Ovariotomy,"  is  based  upon  an  existing  and 
long-felt  necessity  of  a  presentation  in  chrono- 
logical order  of  all  the  facts  pertaining  not  only 
to  the  histories  of  McDowell's  own  cases  and 
operations,  but  to  those  of  his  immediate  fol- 
lowers in  this  country  and  in  Europe,  during 
the  formative  stage,  so  to  speak,  of  his  proce- 
dure by  the  long  incision  (1 809-1 842).  This 
mode  of  studying  and  bringing  out  in  detail  the 
salient  points  of  his  experience  and  that  of  his 
successors,  as  I  propose  to  do  in  this  contribu- 
tion, has  never  before  been  followed,  so  far  as 
I  am  aware,  further  than  by  statistical  tables,  in 
which  circumstances,  histories,  and  peculiarities 
of  cases  have  been  almost  entirely  ignored; 
and  dates,  figures,  and  death-rates  (even  these 
sometimes  being  vague,  unintelligible  and  use- 
less) made  to  take  their  places  with  the  seeming 
intent  in  some  instances  to  prove  to  the  inex- 
perienced physician  the  dangers  and  uncertainty 
of  the  procedure,  rather  than  to  encourage  the 


MCDOWELL'S  OPERATION.  23I 

hesitating  and  faint-hearted,  by  making  clearer 
by  well-digested  principles  and  facts,  the  way 
to  success. 

In  the  outset  it  is  proper  to  point  out  the 
names  of  surgeons  that  have  been  made  to  pre- 
cede that  of  McDowell  in  the  tables  of  statistics 
referred  to.  They  are  Houston,  L'Aumonier, 
Dzondi,  and  Galenzowski.  All,  excepting  the 
latter,  were  connected  with  the  old  method  of 
incision  (incisionism,  if  I  may  be  pardoned  for 
using  the  term),  in  which  procedure  extirpation 
of  the  diseased  ovary  was  not  even  thought  of. 
For  example,  in  the  tables  of  Dr.  Samuel  J. 
Jeaffreson,  and  of  Dr.  Fleetwood  Churchill 
(1844),  L'Aumonier  is  made  to  take  prece- 
dence of  McDowell,  as  a  successful  ovarioto- 
mist,  whereas  he  had  simply  succeeded  by 
incision  in  emptying  a  pelvic  abscess,  presenting 
six  or  seven  weeks  after  parturition.  Again,  in 
the  table  of  the  late  Dr.  W.  L.  Atlee,1  in  addi- 
tion to  the  name  of  L'Aumonier,  those  of 
Houston,  Dzondi,  and  Galenzowski,  are  all 
made  to  precede  that  of  McDowell,  each  in 
the  achievement  of  a  success  by  ovariotomy, 
whereas  neither  Houston  nor  Dzondi  had  the 

1  A  Table  of  all  the  Known  Operations  of  Ovariotomy,  from 
1701  to  1851.     Trans,  of  Am.  Med.  Asso.,  1851. 


232  MCDOWELL'S  OPERATLON. 

slightest  conception  of  extirpation  of  the  ovary ; 
the  former  having  cured  his  case  by  the  old 
method  of  incision  and  a  tent,  and  the  latter, 
whose  case  happened  to  be  an  encysted  dropsy 
of  the  abdomen,  in  a  boy  twelve  years  old, 
effected  his  cure  likewise  by  incision,  tent,  and 
forceps.  As  to  the  third  case  referred  to — that 
of  Galenzowski,  of  Wilna,  West  Russia,  it  was 
simply  an  unfinished  ovariotomy,  performed  in 
accordance  with  the  procedure  of  McDowell  by 
the  long  incision,  eighteen  years  (1827)  after 
the  first  operation  of  the  latter.  The  operator, 
finding  it  impossible  to  remove  the  tumor  on 
account  of  the  numerous  and  strong  adhesions 
found  to  exist,  emptied  the  cyst  by  breaking  up 
its  contents  with  his  hands,  and  then  effected 
an  outlet  for  drainage  through  the  closed  ab- 
dominal wound,  thus  curing  his  patient,  just  as 
any  follower  of  McDowell  would  do  at  the 
present  time  under  similar  circumstances,  and 
would  reasonably  expect  a  like  result. 

Mr.  Benjamin  Phillips,  of  England,  in  his  table 
of  statistics  (1844),  places  the  name  of  McDow- 
ell at  the  head  of  the  list  of  operators,  acknowl- 
edging him  as  the  first  to  perform  ovariotomy. 
M.  Chereau,  of  France  (1844),  not  only  does 
the  same  thing,  but  takes  occasion  to  say  that 


MCDOWELL'S  OPERATION.  233 

he  excludes  the  case  of  L'Aumonier  (his  own 
countryman)  from  the  list  of  successful  ovariot- 
omies, in  which  it  had  previously  been  errone- 
ously included  by  other  writers,  for  the  reason 
that  the  disease  for  which  L'Aumonier  per- 
formed his  operation  "was  abscess  of  the 
ovary,"  and  that  if  he  excised  the  ovary,  as  had 
been  claimed  for  him,  he  did  it  by  chance  or 
accident,  and  not  from  any  preconceived  plan 
of  the  necessity  of  such  a  procedure. 

The  late  Prof.  S.  D.  Gross  also  discovered 
the  great  injustice  to  the  claims  of  McDowell,  at 
home  and  abroad,  in  the  statistical  tables  particu- 
larly referred  to,  and  from  neglect  and  careless- 
ness of  acknowledgment  in  other  ways,  and 
determined  to  bring  out,  as  far  as  possible,  all 
the  facts  relating  to  the  cases  and  operations  of 
McDowell,  which  he  did  in  his  "  Report  on 
Kentucky  Surgery"  (the  State  in  which  he  re- 
sided at  that  time),  presented  at  the  annual 
meeting  at  Louisville  of  the  State  Medical  So- 
ciety, October,  1852.1  This  was  really  the  first 
decisive  defence  of  the  claims  of  McDowell  that 
had  ever  been  made  up  to  that  date.  Dr.  Gross 
took  strong  grounds  regarding  the  absurdity  of 
the  importance  that  previous  writers  had  given 

1  Gross  on  Kentucky  Surgery,  1852. 


234  MCDOWELL'S  OPERATLON. 

to  the  cases  of  L' Aumonier,  Dzondi,  and  Galen- 
zowski,  and  adduced  the  most  cogent  arguments 
to  prove  that  the  results  in  these  three  cases, 
especially,  had  not  the  slightest  claims  of  recog- 
nition as  successful  ovariotomies.  The  result 
was  that  after  the  date  of  Dr.  Gross's  compre- 
hensive and  convincing  contribution  upon  the 
subject,  writers  of  all  countries  came  to  look 
upon  the  claims  of  McDowell  in  the  same  light, 
and  recognized  the  just  value  of  his  labors  in 
giving  to  the  world  ovariotomy,  founded  upon 
correct  principles  of  success,  whatever  the 
method  of  performing  it,  whether  by  long  in- 
cision or  short  incision. 

Dr.  Atlee,  after  the  appearance  of  Dr.  Gross's 
able  defence,  became  thoroughly  convinced  of 
his  error  in  references,  and  the  wrong  thereby 
done  the  claims  of  McDowell  by  having  placed 
his  name  fifth,  instead  of  first,  in  his  table  of 
statistics,  and  afterward  proved  the  sincerity  of 
his  convictions  of  injustice  upon  this  point  by 
dedicating  his  able  work1  in  these  words:  "To 
the  memory  of  Ephraim  McDowell,  M.D.,  of 
Kentucky,  the  Founder  of  Ovariotomy  in  1809 ; 
and  to  John  L.  Atlee,  Sr.,  M.D.,  of  Pennsyl- 
vania, my  Brother,  Preceptor,  and  Friend,  who 

1  Ovarian  Tumors,  1873. 


MCDOWELL'S  OPERATION.  235 

since  1843  has  Aided  in  Establishing  this  Ameri- 
can Operation,  I  Dedicate  this  Volume,  the 
Fruits  of  my  Experience  and  Observation." 

My  object  in  the  study  of  McDowell's  opera- 
tion of  ovariotomy  is  to  present  the  experience 
of  every  surgeon  (in  his  own  words  as  far  as 
possible)  in  a  chronological  order,  as  the  cases 
are  found  recorded,  commencing  with  those  in 
the  United  States  ;  then  taking  up  those  in 
France,  including  here  in  my  discussion  of  the 
subject  a  short  sketch  of  the  old  method  of  in- 
cisionism  ;  next  those  in  Germany,  and  finally 
those  in  Great  Britain ;  the  four  countries,  only, 
in  which  any  considerable  attention  was  given 
the  operation  up  to  the  time  of  its  revival  in 
England  by  Dr.  Charles  Clay,  of  Manchester, 
in  1842,  and  in  the  United  States,  by  the  late 
Dr.  John  L.  Atlee,  of  Lancaster,  Pennsylvania, 
in  1843. 

But  the  plan  here  proposed  of  collecting  the 
facts  in  the  record  of  cases,  as  found  published 
in  the  medical  literature  of  the  several  countries 
named,  is  not  alone  sufficient  to  enable  us  always 
to  seize  upon  the  distinctive  features  of  the  pro- 
cedure employed;  and  a  more  direct  way  of 
discriminating  between  the  real  principles  of  the 
operation  of  McDowell,  and  a  modification  of 


2^6  MCDOWELL'S  OPERATION. 

them,  is  called  for.  The  most  important  prin- 
ciples are  extirpation  of  the  ovary,  his  long 
incision,  and  the  bringing  out  at  the  lower 
angle  of  the  wound  of  the  two  ends  of  the  liga- 
ture on  the  pedicle ;  though  there  is  abundant 
evidence  to  prove,  from  the  histories  of  his 
cases,  that  he  also  employed  the  medium  and 
short  incisions,  when  necessary,  as  well  as  direct 
ligatures  to  individual  arteries  in  the  pedicle, 
omentum,  or  other  parts,  and  even  cut  off  the 
ends  of  the  latter  close  to  the  knots  in  some 
instances. 

Now,  to  understand  and  appreciate  the  im- 
mense and  important  advance  made  by  Mc- 
Dowell in  the  employment  alone  of  his  long 
incision  into  the  upper  division  of  the  abdomen, 
reaching  from  the  ribs  to  the  pubes,  whether 
outside  of  the  recti  muscles  or  in  the  linea  alba, 
it  will  be  necessary  to  glance  at  the  old  method 
of  incisionism,  without  any  regard  to  the  re- 
moval of  the  ovary.  Here,  the  incision  was 
always  made  below  a  line  stretching  trans- 
versely across  the  abdomen  at  the  umbilicus, 
for  the  reason  that  the  disease  was  believed  to 
be  of  a  scirrhous  character,  the  origin  and  seat 
of  which  Avere  at  or  near  the  base  of  the  tumor 
in  the  pelvis,  or  in  one  or  both  of  the  iliac  fossae. 


MCDOWELL'S  OPERATION.  2^7 

With  this  view  of  the  pathology  of  ovarian 
dropsy  at  the  early  period  of  which  we  are 
speaking,  there  existed  a  knowledge  among  the 
incisionists  generally  that  the  seat  of  the  disease 
in  whichsoever  ovary  could  be  recognized  in 
its  early  stage ;  but  at  a  more  advanced  stage 
of  the  disease,  when  the  enlargement  occupied 
both  sides  of  the  abdomen,  the  actual  seat  of 
its  origin  could  not  be  accurately  determined  ; 
hence  the  importance  insisted  upon  by  them  of 
performing  the  operation  early,  before  the  en- 
larging tumor  had  reached  the  umbilicus.  From 
this  arose  the  custom  of  always  making  the 
opening  below  the  umbilicus.  The  operator 
consequently  was  influenced  by  the  point  of 
greater  prominence  in  the  affected  side,  without 
regard  to  the  direction  of  the  line  of  his  incision, 
whether  across  the  fibres  of  muscles  or  the  linea 
alba  or  the  course  of  arteries.  For  example, 
Dr.  Robert  Houston,  of  Great  Britain,  found 
in  his  case  the  tumor  to  occupy  the  left  side, 
extending  up  to  the  umbilicus,  and  he  pro- 
ceeded to  make  his  incision  over  the  most 
prominent  point  of  it :  first,  one  inch,  then  ex- 
tending it  to  three,  and  finally  to  five  inches, 
laying  open,  as  he  proceeded,  the  dropsical 
ovary.     This  he  did  in  1701,  though  the  result 


2^8  MCDOWELL'S  OPERATION. 

was  not  published  until  1724,  as  will  be  seen 
later  on,  and  I  believe  it  to  have  been  the  first 
operation  by  incisionism  ever  performed. 

Le  Dran,  in  France,  began  and  completed 
his  observations  and  experience  in  connection 
with  incisionism  between  the  years  1736  and 
1746.  His  first  operation,  as  described,  was 
in  the  case  of  a  tumor  in  the  left  side,  but  a 
puncture  had  been  made  in  the  right  side  by 
the  physician  previously  in  charge,  since,  from 
the  size  of  the  tumor,  he  was  unable  to  decide 
the  seat  of  origin.  Here  Le  Dran  made  his 
incision,  from  the  puncture  in  the  right  side 
downward,  four  inches  in  length,  and  large 
enough  to  admit  two  fingers  ;  but,  not  finding 
the  tumor  on  this  side,  he  was  led,  several 
months  later,  to  make  a  transverse  incision 
from  the  point  named  to  the  left  side,  about 
four  fingers'  breadth  above  the  pubes,  cutting 
across  the  muscles  and  arteries,  to  the  extent 
of  six  to  seven  inches.  He  then  introduced  his 
hand  for  exploration.  In  his  second  case  he 
made  a  medium  incision  in  the  linea  alba,  ex- 
tending from  the  umbilicus  to  the  pubes  ;  his 
object  being  in  this  instance  to  guard  against  a 
prompt  closure  of  the  abdominal  wound,  and  to 
favor  the  contraction  of  the  cyst  by  inflamma- 


MCDOWELL'S  OPERATION.  2$g 

tion  and  suppuration  of  its  walls,  induced  by 
the  use  of  a  tent  or  drainage  tube  with  injec- 
tions, thus  keeping  all  the  while  the  outlet  of 
the  cyst  near  its  bottom — the  scirrhous  seat  of 
the  disease. 

Delaporte,  a  few  years  later,  doubtless  a  fol- 
lower of  Le  Dran,  found  a  semi-solid  tumor  fill- 
ing the  entire  abdomen,  but  was  influenced  by 
the  greater  prominence  of  the  left  side,  to  make 
his  incision  there.  It  was  four  inches  in  length, 
and  the  same  opened  up  the  tumor.  The  re- 
sult was,  so  great  was  the  flow  of  the  con- 
tained gelatinous  fluid,  that  no  further  attempt 
was  made  at  exploration  for  several  days,  and 
even  then  to  no  effect,  since  we  are  told  that 
the  flow  continued  more  or  less  free  until  the 
eleventh  day,  when  the  patient  expired.  It  was 
from  the  autopsy  in  this  case  that  he  discovered 
the  actual  seat  of  the  disease  to  be  in  the  right 
ovary  instead  of  in  the  left.  From  these  obser- 
vations, and  much  to  his  credit,  he  made  the 
first  suggestion  or  proposal  "  to  remove  the 
focus  of  the  disease — namely,  the  tumor  formed 
by  the  ovary." 

When  Delaporte  suggested  the  possibility  of 
removing  "the  focus  of  the  disease"  in  the 
ovary,  he  was  no  doubt  overawed  by  the  enor- 


240  MCDOWELL'S  OPERATION. 

mous  size  of  the  multilocular  cyst  he  had  just  en- 
countered, and  fully  impressed  with  the  utter 
impossibility  of  any  one  determining  beforehand 
the  particular  ovary  involved  in  such  a  case. 
He,  therefore,  made  the  proposal  credited  to 
him,  under  the  conviction  that  if  it  were  ever 
executed,  it  would  have  to  be  done  when  the 
disease  was  in  its  early  stage.  All  incisionists 
insisted  upon  this  early  attention  to  the  state  of 
the  tumor ;  and  even  Morand,"  in  commenting 
upon  the  cases  of  Le  Dran  and  Delaporte,  em- 
phasized the  importance  of  this  precaution,  even 
stating  that  if  the  latter  had  acted  upon  this 
principle  and  operated  earlier,  the  result  in  his 
case  might  have  been  different. 

Incisionism,  including  tent  and  drainage-tube 
with  injections,  for  the  cure  of  dropsical  ova- 
ries would  seem  to  have  reached  the  limit  of 
popularity  with  Delaporte' s  case,  and  his  sug- 
gestion of  the  preferableness  of  removing  the 
organ  itself,  "  the  focus  of  the  disease,"  which 
was  about  or  just  after  the  middle  of  the  cen- 
tury (1753).  Nevertheless,  the  practice  con- 
tinued to  receive  more  or  less  attention. 
Theden,  of  France,  soon  after  Delaporte's  pro- 
posal, projected  the  plan  of  an  operation  com- 
bining with  incisionism  the  latter's  suggestion 


MCDOWELL'S  OPERATLON.  24 1 

of  the  removal  of  the  ovary.  This  he  proposed 
to  do  by  a  short  incision  in  the  inguinal  region, 
based  upon  the  idea  that  the  diseased  ovary 
here  was  outside  the  peritoneum.  After  ex- 
posing the  ovary,  and  giving  vent  to  the  con- 
tained fluid,  he  would  finish  by  drawing  out  the 
sac  and  putting  a  ligature  upon  its  point  of 
attachment,  leaving  both  ends  of  the  latter 
hanging  out  of  the  wound.  If  the  organ  were 
found  hardened  he  would  bring  it  out  with  his 
fingers,  putting  the  ligature  on  to  cause  its 
destruction.  According  to  circumstances  he 
would  tighten  the  ligature,  but  to  prevent  acci- 
dent he  would  amputate  the  ovary.  This 
scheme,  such  as  it  was,  of  associating-  the  old 
method  of  incisionism  in  the  lower  division  of 
the  abdomen  with  the  removal  of  the  ovary  in 
the  way  just  pointed  out,  was  at  the  time  ex- 
tolled by  Morand,  and  discussed  and  com- 
mented upon  with  great  enthusiasm  by  Power 
and  Darwin,  of  England. 

From  these  notices  and  recommendations  of 
the  proposal  there  is  reason  to  believe  that 
Dr.  Wm.  Hunter,  as  we  shall  see  in  the  English 
history  of  the  subject,  was  led,  in  1757  (familiar 
with  incisionism),  to  make  his  very  pertinent 
remarks  upon  the  pathology  of  dropsical  cyst 
16 


242  MCDOWELL'S  OPERATION. 

of  the  ovary  and  the  suggestion  of  a  method 
by  which  the  tumor,  composed  of  one  or  two 
small  cysts,  could  be  exposed  by  a  small  inci- 
sion, admitting  "  two  fingers  or  so,"  punctured, 
drawn  out,  and  excised.  There  is  no  evidence, 
however,  to  show  that  either  the  recommenda- 
tions of  Theden  or  his  own  were  ever  put  into 
practice  in  France  or  England. 

L'Aumonier's  operation,  performed  in  1782, 
as  will  be  pointed  out  at  length  in  the  French 
history  of  the  subject,  was  unquestionably  an 
extension  of  the  old  method  of  incisionism,  and 
the  claim  of  removal  of  the  ovary  is  here  made 
very  much  as  described  by  Theden,  except  that 
no  mention  is  made  of  a  ligature  ;  though  the 
facts  do  not  warrant  such  a  claim  to  success, 
the  case  having  been  one  of  simple  pelvic  ab- 
scess relieved  by  puncture. 

M.  d'Ischier  in  his  inaugural  thesis  [Theses 
de  Montpellier,  1807)  endeavored  to  maintain 
L'Aumonier's  claim  of  successful  removal  of 
the  ovary  in  the  operation  referred  to,  though, 
according  to  the  high  authority  of  Prof.  Vel- 
peau,  he  failed  to  do  so. 

Thus,  from  all  that  has  been  said  of  incision- 
ism, extending  for  a  period  of  108  years  up  to 
the  time  of  McDowell's  operation,  1809 — it  is 


MCDO  WELL'S  OPERA  TION. 


243 


clear  that  the  general  rule  of  the  incisionists 
was  to  make  the  opening  into  the  abdomen 
below  the  umbilicus,  with  the  idea  of  curing  the 
dropsical  cyst  by  causing  inflammation  and 
suppuration  of  the  walls  of  the  same  by  injec- 
tions and  drainage.  The  safety  of  making  inci- 
sions in  several  directions  into  the  lower  divi- 
sion of  the  abdomen  was  certainly  proved  by 
Houston  and  Le  Dran  ;  while  of  the  proposal 
made  by  Delaporte  of  removal  of  the  ovary, 
there  seems  to  be  no  doubt,  with  also  a  fair 
show  of  probability,  that  Theden,  in  the  plan 
projected  by  him  of  an  operation  for  removal 
of  a  dropsical  ovary,  understood  the  necessity 
of  employing  a  ligature  on  the  pedicle  to  pre- 
vent hemorrhage. 

Whether  Dr.  McDowell  knew  anything 
about  this  previous  work  of  incisionism  as 
applied  to  the  lower  division  of  the  abdomen,  or 
of  Hunter's  proposal  of  removal  of  the  ovary 
by  a  short  incision,  or  of  the  employment  of  a 
ligature  on  the  pedicle,  no  one  can  positively 
say.  It  is  well  known,  however,  that  he  was  a 
student  of  medicine  in  the  University  of  Edin- 
burgh, and  a  pupil  while  there  of  the  celebrated 
Mr.  John  Bell  (1793-94),  who  was  thoroughly 
well  informed  in  everything  that  related  to  sur- 


244 


MCDO  WELL  >S  OPERA  TION. 


gery.  The  natural  inference,  therefore,  is  that 
the  pupil,  known  to  have  been  a  close  and  dili- 
gent student,  became  interested  in  the  question 
of  incisionism  and  the  proposed  extirpation  of 
the  ovary,  as  taught  at  that  period,  and  gave 
the  subject  more  than  ordinary  attention.  Be 
this  as  it  may,  certain  it  is  that  the  brilliant  and 
instructive  lectures  by  Mr.  Bell,  listened  to  by 
McDowell,  gave  no  encouragement  to  a  hope- 
ful outlook  as  to  any  future  development  of  the 
operation  in  question,  since  not  a  single  exam- 
ple of  extirpation  of  a  diseased  ovary  had  taken 
place  in  any  country  up  to  that  date,  or  did  occur 
up  to  the  time  of  McDowell's  conception  and 
first  performance  of  such  an  operation  in 
December,  1809. 

When,  therefore,  McDowell  made  his  long 
incision,  extending  into  the  upper  division  of 
the  abdomen,  from  the  margin  of  the  ribs  or 
ensiform  cartilage  to  the  pubes,  he  did  what  no 
other  operator  had  ever  done  or  thought  of 
before,  and  by  so  doing  was  the  first  to  "  remove 
the  focus  of  the  disease  ;  namely,  the  tumor 
formed  by  the  ovary,"  as  casually  suggested 
by  Delaporte  fifty-six  years  previously ;  thus 
instituting  a  new  departure,  original  and  com- 
plete.    By  the    same    step    and    at   the    same 


MCDOWELL'S  OPERATION.  245 

time  was  associated  with  this  long  incision  (but 
little,  if  any,  less  important)  the  fullest  ex- 
ploration possible  for  the  discovery  of  C(  the 
focus  of  the  disease — the  tumor  formed  by 
the  ovary,"  as  well  as  the  complications  pre- 
sent, of  whatsoever  gravity  or  extent,  whether 
above  or  below  the  umbilicus. 

McDowell's  boldness  and  his  advance  upon 
ineisionism  are  to  be  found  mainly  in  these 
three  steps  :  namely,  the  long  incision  reaching 
into  the  upper  division  of  the  abdomen,  the 
widest  exploration  possible  of  the  peritoneal 
cavity,  and  the  successful  extirpation  of  a  drop- 
sical ovary.  The  fact  of  his  having  only  empha- 
sized the  long  incision  in  his  first  trial  of  it,  does 
not  prove  by  any  means  that  he  was  ignorant 
of  the  advantages  of  the  short  and  medium 
incisions  in  the  lower  division  of  the  abdomen, 
since  he  proved  the  contrary  in  his  published 
cases ;  that  he  employed  both  of  these  forms  of 
incision,  first  for  the  introduction  of  the  finger 
into  the  abdomen,  and  second  of  the  hand,  alike 
for  explorative  and  operative  purposes. 

It  is  proper  to  mention  in  this  connection  the 
error  of  a  few  of  McDowell's  immediate  fol- 
lowers, who,  supposing  that  he  was  not  familiar 
especially  with  the  use   of  the   short    incision, 


246  MCDOWELL'S  OPERATLON. 

thought  (no  doubt  honestly)  that  they  had  made 
an  improvement  in  practising  it ;  some  of  them 
even  claiming  originality  in  the  employment  of 
this  form  of  incision,  restricted  to  the  limits  of 
one  to  four  inches.  Among  these  surgeons 
were  Dr.  Nathan  Smith,  in  the  United  States, 
and  Messrs.  Jeaffreson,  King,  West,  Phillips, 
and  several  others  in  England.  The  results  of 
their  operations  by  this  short  incision  proved, 
as  is  well  known,  unfortunate  both  for  their 
claims  of  improved  success  and  for  science, 
since  the  dangers  incident  to  the  trial  of  the 
procedure  could  only  be  determined  by  a  con- 
siderable number  of  cases,  and  this  consumed 
four  or  five  years.  Thus  was  the  general  ac- 
ceptance of  McDowell's  procedure  by  his  long 
incision  delayed,  and  the  development  of  its  real 
merits  prevented,  much  longer  than  would 
otherwise  have  been  the  case. 

The  question  of  the  defectiveness  of  the  short 
incision  was  no  doubt  fully  settled  in  the  mind 
of  McDowell  before  he  ever  decided  upon  mak- 
ing his  long  incision,  as  proved  by  the  extra- 
ordinary boldness  with  which  he  carried  the 
plan  of  the  latter  out  in  his  first  case,  and  the 
persistent  employment  of  it  afterward  in  one  or 
two  of  his  cases,  where  the  medium  incision 
would  have  answered  just  as  well. 


MCDOWELL'S  OPERATLON.  2/>j 

It  was,  therefore,  the  utter  failure  of  the  short 
incision,  as  employed  by  the  surgeons  named, 
to  furnish  the  requisite  scope  and  facilities  for 
exposure  of  the  tumor  and  for  manipulation  in 
the  abdomen,  except  in  simple  and  uncompli- 
cated cases,  that  the  wider  range  of  application 
of  McDowell's  long  incision  came  finally  to  be 
seen  and  appreciated.     With  this  revulsion  of 
feeling  on    so    important  a  point  there  was  a 
cessation  in  the  employment  of  the  short  incision 
just  after  the  disastrous  result   that   followed 
Mr.  Benjamin  Phillips's  operation  (1840),  from 
hemorrhage  caused,  no  doubt,  by  the  dragging 
of  the  collapsed  cyst  walls  through  an  abdomi- 
nal opening  too  small,  and  the  laceration  of  the 
broad  ligament  or  some  other  unduly-exposed 
structure.      It  was  due  to  such   consequences 
and  the  utter  inability  of  the  advocates  of  the 
procedure  to  answer  such  a  potent  objection  as 
this  and  others  that  might  be  adduced,  that  the 
attention  of  the  profession  was  directed  anew 
to  the   superior  advantages  of  the   McDowell 
procedure  by  the  long  incision.      This  renewed 
investigation  led  to  the  revival  of  his  operation, 
and  in  this  movement,  as  previously  mentioned, 
Dr.  Charles  Clay,  of  England,  was  foremost. 
The  distinctive   advantages    of  McDowell's 


248  MCDOWELL'S  OPERATLON. 

long  incision  as  compared  with  the  short  incision, 
therefore,  may  again  be  repeated  as  follows: 
The  laying  open  of  the  entire  abdomen ;  the 
exposure  of  the  tumor  in  whatsoever  stage  of 
its  growth ;  the  searching  for  and  overcoming 
of  adhesions  ;  and  the  guarding  against  injury 
to  the  surrounding  organs.  The  association  of 
these  principles,  as  shown  in  the  reports  of 
McDowell's  first  five  cases  (1809-18 19)  gave 
him  three  successes  out  of  four  completed 
operations.  One  operation  was  unfinished  on 
account  of  the  existence  of  a  sessile  fibrous 
growth  of  the  uterus  ;  and  in  this  case  the  pa- 
tient recovered.  This  is  a  degree  of  advance- 
ment in  diagnosis  and  the  achievement  of  prac- 
tical results  from  the  procedure  by  McDowell 
himself  that  can  be  but  little,  if  at  all,  surpassed 
by  the  majority  of  operators  at  the  present  day. 
As  to  what  has  now  been  said  in  condemna- 
tion of  the  short  incision  for  the  extirpation  of 
dropsical  ovaries  of  the  semi-solid  character,  and 
even  of  the  simpler  forms  complicated  with 
extensive  adhesions,  I  may  be  permitted  here  to 
add  that  the  same  general  principles  underlying 
the  employment  of  the  long  incision  apply  with 
almost  equal  force  to  the  importance  of  discrim- 
inating between  the  range  of  adaptation  of  the 


MC D O  WELL'S  OPERA  TION. 


249 


short  and  the  medium  incisions,  restricted,  as  in 
the  days  of  old  incisionism,  to  the  lower  division 
of  the  abdomen.  This  view  of  the  subject,  with 
regard  to  pathology  and  diagnosis,  I  believe  to 
be  strictly  correct,  not  only  for  the  removal  of 
simple  or  multiple  cysts  of  palpable  size,  but 
(as  in  laparotomy  of  to-day)  for  operations  for 
"deep-seated  pelvic  pains,"  for  "pus  tubes,"  or 
for  "fixed"  or  "cystic  ovaries"  of  impalpable 
size,  having  whatsoever  "focus  of  disease"  or 
complications,  and  sometimes  requiring,  as 
alleged,  one  or  more  repetitions. 

A  typical  example  of  the  superior  advantages 
of  the  long  incision  of  McDowell,  as  illustrated 
in  the  case1  of  a  large  semi-solid  tumor  (multi- 
locular)  which  I  operated  upon  in  Coosa  County, 
Alabama,  a  little  over  a  quarter  of  a  century 
ago  (January  14,  1865),  I  will  introduce  here  in 
further  contrast  of  what  has  already  been 
brought  out  in  regard  to  the  short  incision. 

This  patient  had  previously  been  tapped 
seven  times,  and  the  aggregate  of  fluid  drawn 
off  was  computed  at  thirty-five  gallons.  The 
tumor  occupied  the  entire  abdomen  and  part  of 
the  pelvis,  with  considerable  protuberance  to 
the  left  and  just  below  the  umbilicus,  and  the 

1  N.  Y.  Med.  Record,  Sept.  i,  1866. 


250  MCDOWELL'S  OPERATION. 

subcutaneous  veins  over  the  abdomen  were 
very  much  enlarged.  The  operation  was  com- 
menced in  the  entire  extent  of  the  linea  alba 
below  the  umbilicus  (medium  incision),  but  this 
being  found  too  small  for  exposing  and  dealing 
with  the  strong  and  extensive  adhesions  found 
to  exist  upon  both  sides  of  the  incision,  it  was 
extended  to  the  ensiform  cartilage,  making  the 
whole  length  fourteen  inches.  This  brought  to 
view  the  same  character  of  adhesions  above  the 
umbilicus  as  below  it.  After  proceeding  for  a 
short  distance  in  the  breaking  up  of  the  adhe- 
sions on  either  side  of  the  incision,  with  the 
fingers  and  handle  of  the  scalpel,  the  tumor  was 
opened  at  the  prominent  point  indicated  (to  the 
left  of  the  umbilicus)  and  about  three  gallons 
of  gelatinous  fluid  removed.  With  this  the 
breaking  up  of  adhesions  was  continued  on  both 
sides  to  the  entire  extent  of  the  abdominal 
mass,  there  being  several  points  behind  to 
which  the  small  intestines  were  found  to  adhere, 
requiring  careful  dissections  for  their  separation. 
This  being  completed,  the  large  abdominal  mass 
was  lifted  up  and  supported  while  the  pelvic 
part  of  it,  thus  disengaged  now  in  its  entire 
extent,  was  dislodged  from  Douglass's  pouch. 
The  pedicle  was  next    secured  with  a  double 


MC  D  O  WEL  L '  S  OPERA  TION. 


2~s\ 


silver  ligature,  cut  off  close  to  the  knots,  and  the 
tumor  then  cut  away.  After  freeing  the  abdo- 
men of  all  fluids  (there  being  but  little  hemor- 
rhage), the  wound  was  closed  in  the  usual  way. 
The  tumor,  with  the  three  gallons  of  fluid  re- 
moved in  the  operation,  weighed  forty-five 
pounds,  the  weight  of  the 'patient  being  about 
ninety.  The  patient  made  a  slow  but  complete 
recovery. 

This  was  my  understanding  of  the  superior 
advantages  of  the  long-  incision  of  McDowell 
over  the  short  and  medium  incisions.  As  to 
the  result,  the  case  speaks  for  itself.  There  is 
no  surgeon,  I  venture  to  say,  having  a  correct 
knowledge  and  appreciation  of  the  principle  of 
the  long  incision  as  here  employed,  who  can 
claim  that  such  a  tumor,  two-thirds  solid,  and 
complicated  with  such  adhesions,  could  have 
been  removed  successfully  by  either  the  short 
or  medium  incision.  Such  is  the  class  of  cases 
in  which  a  wider  range  is  claimed  for  this  long 
incision  than  is  possible  for  any  other,  or  com- 
bination of  incisions. 

In  my  somewhat  large  experience  since,  in 
the  employment  of  abdominal  sections  for  the 
removal  of  both  fibrous  and  ovarian  tumors,  in 
a  large  proportion  of  the  cases  (amounting  to 


2e2  MCDOWELL'S  OPERATLON. 

one-third,  at  least)  I  have  found  the  same  neces- 
sity for  the  long  incision  of  McDowell  as  above 
described ;  even  in  a  second  case1  I  may  men- 
tion, the  necessity  arose  in  the  extirpation  of  a 
large  cyst  of  the  pancreas — hitherto  and  up  to 
the  present  time,  so  far  as  I  am  aware,  the  only 
case  on  record  of  a  successful  removal. 

It  is  these  observations  and  the  results  I  have 
obtained  from  the  employment  of  the  long  in- 
cision of  McDowell,  that  form  my  excuse  for 
the  presentation  of  the  subject  in  these  pages 
and  the  statement  of  my  conviction  of  the  obli- 
gations of  the  profession  to  McDowell  for  hav- 
ing given  to  the  world  a  perfected  operation, 
as  far-reaching  in  its  grand  results  to-day  as 
when  he  first  performed  it. 

Having  now  carefully  examined  McDowell's 
operation  of  ovariotomy  by  his  long  incision, 
made  in  both  the  lower  and  upper  divisions  of 
the  abdomen ;  shown  its  relation  to  the  old 
method  of  incisionism,  restricted  alone  to  the 
lower  division  of  the  abdomen,  and  practised 
without  the  slightest  knowledge  of  the  possi- 
bility of  removing  the  dropsical  ovary  itself; 
contrasted  its  principles  with  those  of  the  short 

1  N.  Y.  Med.  Record,  Jan.  14,  1882,  p.  46.  Ibid.,  by  Dr.  H.  J. 
Garrigues,  p.  286 ;  also  Diagnosis  of  Ovarian  Cysts,  Garrigues, 
1882,  p.  86. 


MCDOWELL'S  OPERATION.  253 

incision ;  pointed  out  its  languishing  existence 
and  slender  hold  upon  the  confidence  of  the 
profession  for  so  many  years ;  its  final  revival 
in  England  and  the  United  States;  and  cited 
two  typical  cases  illustrating  its  absolute  and 
superior  advantages  over  all  other  incisions  of 
whatsoever  character  or  combination,  it  remains 
to  explain  how  the  operation  has  been  studied 
and  its  principles  brought  out  in  this  and  the 
several  countries  of  Europe  previously  named. 

Commencing  with  the  immediate  followers 
of  McDowell  in  the  United  States,  the  details 
of  whose  cases  will  appear  in  regular  order,  only 
one  of  them  (Dr.  Nathan  Smith)  employed  the 
short  incision,  and  one  (Dr.  Alban  G.  Smith) 
employed  the  medium  incision  ;  the  others 
(including  Drs.  Mussey,  Rogers,  Warren  and 
Bellinger)  employed  the  long  incision,  and  the 
operations  were  completed  in  all  except  in  the 
case  of  Dr.  Mussey,  and  in  two  of  Dr.  Nathan 
Smith's,  in  which  they  were  unable  to  remove 
the  tumors. 

In  France  there  is  no  case  on  record,  so  far 
as  I  have  been  able  to  discover,  in  which  the 
operation  of  McDowell  was  employed  during 
the  period  of  its  history  under  consideration. 
There  is   much  of  importance,  however,  con- 


2ca  MCDOWELL'S  OPERATLON. 

nected  with  the  old  method  of  incisionism,  em- 
ployed for  the  cure  of  dropsical  ovaries,  and  in 
the  general  relation  of  this  procedure  to  Mc- 
Dowell's operation  by  the  long  incision.  These 
are  interesting  points  which  I  have  brought 
out,  as  will  appear  when  we  come  to  consider 
them. 

To  Germany  we  are  to  look  for  the  first 
recognition  and  employment  of  McDowell's 
procedure — a  fact  which  has  not  hitherto,  as 
far  as  I  am  aware,  been  brought  to  the  notice 
of  the  profession,  as  shown  by  the  various  pub- 
lications I  have  examined.  Upon  this  point  I 
am  able  to  speak  with  much  confidence,  since 
the  details  of  the  operations  performed  are  given, 
with  so  much  precision  by  the  surgeon  (Dr. 
Chrysmar)  in  the  reports  of  his  three  cases, 
though  the  name  of  McDowell  is  not  mentioned 
in  a  single  instance  in  connection  with  these 
operations.  The  histories  of  them  have  come 
down  to  us  through  the  reports  of  Dr.  Hopfer, 
of  Biberbach,  to  whom  these  operations  have 
been  erroneously  credited  in  various  statistical 
tables  ;  but  the  facts  show  that  he  makes  no  pre- 
tensions to  a  claim  of  any  operation  that  he  ever 
performed,  but  only  to  have  witnessed  some  of 
the  operations  of  Dr.  Chrysmar,  and  to  have 


MCDOWELL'S  OPERATLON.  255 

.    sent  one  of  the  three  cases  to  him  specially  for 
operation. 

Dr.  Chrysmar's  home  at  the  time  of  his  opera- 
tions, was  in  Isny,  in  the  Kingdom  of  Wurtem- 
berg,  and  he  is  reported  by  Dr.  Hopfer  as 
enjoying  at  that  period  a  wide  reputation,  ex- 
•  tending  into  the  adjacent  countries  of  Austria 
and  Bavaria.  His  first  operation  was  performed 
on  May  16,  1819,  just  two  years  after  the  ap- 
pearance of  Dr.  McDowell's  first  three  cases 
in  the  Philadelphia  Eclectic  Reportory,  and  four 
months  before  he  sent  his  second  paper  (Sep- 
tember, 1 8 19)  to  Dr.  James,  in  Philadelphia,  for 
publication  in  the  same  periodical.  Dr.  Chrys- 
mar's second  operation  was  performed  in  1820, 
and  his  third  in  August,  1820.  His  first  two 
operations  are  probably  the  ones  referred  to  by 
Mr.  John  Lizars,  of  Edinburgh,  in  his  introduc- 
tion to  McDowell's  first  three  cases,  published 
by  the  former  in  the  Edinburgh  Medical  a7id 
Surgical  Journal  for  October,  1824.  Here  he 
says  that  extirpation  of  the  ovary  had  previ- 
ously been  performed  in  France  and  Germany, 
leaving  the  reader  to  infer  that  the  operation 
was  performed  in  these  countries  prior  to  the 
date  of  McDowell's  first  operation  in  1809,  he 
then   having   had   the    report   of    McDowell's 


256  MCDOWELL'S  OPERATLON. 

first  three  cases  in  his  possession  for  seven 
years. 

All  of  the  other  operations  performed  in  Ger- 
many after  this  are  more  or  less  distinctive  of 
McDowell's  procedure,  especially  as  regards 
his  long  incision.  Dr.  Dolhoff,  of  Magdeburg, 
Prussia,  reports  a  false  diagnosis  in  his  third 
case.  From  the  history  given  of  the  case  there 
is  no  doubt  in  my  mind  that  the  mistake  in  diag- 
nosis (consequently  the  unjustifiable  operation 
that  was  performed)  resulted  from  the  existence 
of  chronic  cystitis,  and  probably  of  pyelitis 
brought  about  by  repeated  attacks  of  hysteri- 
cal retention  of  urine.  The  special  groups  of 
symptoms  usually  attendant  upon  these  affec- 
tions are  set  forth  more  or  less  in  detail  in  the 
history  given. 

In  Great  Britain  our  attention  is  naturally 
directed  first  to  the  important  operation  of  Dr. 
Robert  Houston,  by  the  old  method  of  incision- 
ism — the  first  case,  as  far  as  we  can  determine 
from  our  investigation  of  the  subject,  as  has 
been  previously  stated.  Mrs.  Margaret  Millar, 
who  resided  near  Glasgow,  Scotland,  aged  fifty- 
eight,  was  the  subject  of  this  treatment,  and 
Dr.  Houston's  operation  was  performed  August, 
1 701,  as  found  published  in  the  London  Philo- 


MCDOWELL'S  OPERATION.  2^J 

sophical  Transactions,  in  1724,  twelve  years 
before  the  date  of  Le  Dran's  first  operation 
by  the  same  procedure  in  France  (1736). 

In  this  connection  we  note  the  published  views 
of  Dr.  William  Hunter,  entitled  Medical  Ob- 
servations and  Inquiries,  London,  1762,  which 
will  appear  in  their  proper  place,  as  previously 
indicated  ;  as  well  as  certain  statements  of  Prof. 
James  Blundell,  in  his  "  Researches,  Physiologi- 
cal and  Pathological,"  tending  to  prove  the  safety 
of  the  operation  of  extirpation  of  the  ovary,  and 
the  justifiability  in  surgeons  performing  it. 

The  explanation  of  the  extraordinary  course 
pursued  by  Mr.  John  Lizars  toward  Dr.  Mc- 
Dowell in  withholding  his  cases  from  publica- 
tion for  seven  years,  as  given  in  connection 
with  the  report  of  his  own  first  case,  operated 
upon  by  the  long  incision  of  McDowell  (Octo- 
ber 24,  1823),  will  be  learned  from  extracts 
presented,  while  comments  will  be  given  upon 
the  details  of  this  and  his  other  three  cases, 
in  all  of  which  McDowell's  procedure  was 
employed. 

In  this  connection  also  will  appear  the  unjust 

criticisms  of  Dr.  James  Johnson,   the  learned 

editor  of  the  Medico-  Chirurgical  Review \  upon 

the  operation  of  McDowell,  together  with  his 

17 


25> 


MCDO  WELD  S  OPERA  TIOJV 


retractions  of  the  same  after  discovering-  his 
error. 

The  several  other  operations  performed  in 
Great  Britain  after  those  of  Mr.  Lizars  may  be 
said  to  be  principally  the  short  incision  opera- 
tions of  William  Jeaffreson,  Esq.,  of  Framling- 
ham,  England,  and  his  imitators,  as  already 
referred  to,  of  which  cases  abstracts,  more  or 
less  in  detail,  will  be  found  in  the  regular  order 
of  presentation. 

Having  concluded  our  general  survey  of  the 
subject  before  us,  we  are  now  better  prepared 
to  appreciate  the  historical  facts  to  be  brought 
out  more  in  detail  and  commented  upon. 

The  plan,  as  foreshadowed,  will  be  to  divide 
the  subject  into  four  sections,  corresponding  to 
the  countries  referred  to,  commencing  with  the 
United  States.  Naturally  this  brings  us  first  to 
the  presentation  of  McDowell's  eight  cases, 
five  of  which  are  copied  in  full,  with  abstracts 
of  criticisms  upon  his  operation  and  quotations 
from  the  same,  together  with  answers  and  com- 
ments thereupon  by  himself.  Of  the  remaining 
three  cases  the  facts  presented  are  based  upon 
the  highest  authority. 


IN  THE  UNITED  STATES.  2$g 

SECTION     I. 

UNITED    STATES. 

Three   Cases  of  Extirpation  of  Diseased  Ovaria,1 
By  Ephraim  McDowell,  M.D.,  of  Danville,  Kentucky. 

In  December,  1809, 1  was  called  to  see  a  Mrs.  Crawford, 
who  had  for  several  months  thought  herself  pregnant.  She 
was  affected  with  pains  similar  to  labor  pains,  from  which 
she  could  find  no  relief.  So  strong  was  the  presumption 
of  her  being  in  the  last  stage  of  pregnancy  that  two  phy- 
sicians, who  were  consulted  on  her  case,  requested  my  aid 
in  delivering  her.  The  abdomen  was  considerably  enlarged 
and  had  the  appearance  of  pregnancy,  though  the  inclina- 
tion of  the  tumor  was  to  one  side,  admitting  of  an  easy 
removal  to  the  other.  Upon  examination,  per  vaginam, 
I  found  nothing  in  the  uterus,  which  induced  the  conclu- 
sion that  it  must  be  an  enlarged  ovarium.  Having  never 
seen  so  large  a  substance  extracted,  nor  heard  of  an  attempt 
or  success  attending  any  operation  such  as  this  required,  I 
gave  to  the  unhappy  woman  information  of  her  dangerous 
situation.  She  appeared  willing  to  undergo  an  experiment, 
which  I  promised  to  perform  if  she  would  come  to  Dan- 
ville (the  town  where  I  live),  a  distance  of  sixty  miles  from 
her  place  of  residence.  This  appeared  almost  impracticable 
by  any,  even  the  most  favorable  conveyance,  though  she 
performed  the  journey  in  a  few  days  on  horseback.  With 
the  assistance  of  my  nephew  and  colleague,  James  Mc- 
Dowell, M.D.,  I  commenced  the  operation,  which  was 
concluded  as  follows  :  Having  placed  her  on  a  table  of  the 
ordinary  height,  on  her  back,  and  removed  all  her  dressing 
which  might  in  any  way  impede  the  operation,  I  made  an 

xThe  Eclectic  Repertory,  1817,  vol.  vii.,  p.  242. 


25q  MCDOWELL'S  OPERATLON 

incision  about  three  inches  from  the  musculus  rectus  ab- 
dominis, on  the  left  side,  continuing  the  same  nine  inches 
in  length,  parallel  with  the  fibres  of  the  above-named  mus- 
cle, extending  into  the  cavity  of  the  abdomen,  the  parietes 
of  which  were  a  good  deal  contused,  which  we  ascribed  to 
the  resting  of  the  tumor  on  the  horn  of  the  saddle  during 
her  journey.  The  tumor  then  appeared  full  in  view,  but 
was  so  large  that  we  could  not  take  it  away  entire.  We 
put  a  strong  ligature  around  the  Fallopian  tube  near  the 
uterus,  and  then  cut  open  the  tumor,  which  was  the  ovarium 
and  fimbrious  part  of  the  Fallopian  tube  very  much  en- 
larged. We  took  out  fifteen  pounds  of  a  dirty,  gelatinous- 
looking  substance,  after  which  we  cut  through  the  Fallopian 
tube  and  extracted  the  sack,  which  weighed  seven  pounds 
and  one-half.  As  soon  as  the  external  opening  was  made 
the  intestines.rushed  out  upon  the  table,  and  so  completely 
was  the  abdomen  filled  by  the  tumor  that  they  could  not 
be  replaced  during  the  operation,  which  was  terminated 
in  about  twenty-five  minutes.  We  then  turned  her  upon 
her  left  side,  so  as  to  permit  the  blood  to  escape,  after 
which  we  closed  the  external  opening  with  the  interrupted 
suture,  leaving  out,  at  the  lower  end  of  the  incision,  the 
ligature  which  surrounded  the  Fallopian  tube.  Between 
every  two  stitches  we  put  a  strip  of  adhesive  plaster,  which, 
by  keeping  the  parts  in  contact,  hastened  the  healing  of 
the  incision.  We  then  applied  the  usual  dressings,  put  her 
to  bed,  and  prescribed  a  strict  observance  of  the  anti- 
phlogistic regimen.  In  five  days  I  visited  her,  and  much 
to  my  astonishment  found  her  engaged  in  making  up  her 
bed.  I  gave  her  particular  caution  for  the  future,  and  in 
twenty-five  days  she  returned  home  as  she  came,  in  good 
health,  which  she  continues  to  enjoy. 

Since  the  above  case  I  was  called  to  a  negro  woman, 
who  had  a  hard  and  very  painful  tumor  in  the  abdomen 
(1813).  I  gave  her  mercury  for  three  or  four  months  with 
some  abatement  of  pain,  but  she  was  still  unable  to  perform 
her  usual  duties.     As  the  tumor  was  fixed  and  immovable, 


IN  THE  UNITED  STATES.  26l 

I  did  not  advise  an  operation ;  though,  from  the  earnest 
solicitation  of  her  master,  and  her  own  distressful  condition, 
I  agreed  to  the  experiment.  I  had  her  placed  upon  a 
table,  laid  her  side  open  as  in  the  above  case,  put  my  hand 
in,  found  the  ovarium  very  much  enlarged,  painful  to  the 
touch,  and  firmly  adhering  to  the  vesica  urinaria  and  fundus 
uteri.  To  extract  I  thought  would  be  instantly  fatal ;  but, 
by  way  of  experiment,  I  plunged  the  scalpel  into  the  dis- 
eased part.  Such  gelatinous  substance  as  in  the  above 
case,  with  a  profusion  of  blood,  rushed  to  the  external 
opening,  and  I  conveyed  it  off  by  placing  my  hand  under 
the  tumor  and  suffering  the  discharge  to  take  place  over  it. 
Notwithstanding  my  great  care,  a  quart  or  more  of  blood 
escaped  into  the  abdomen.  After  the  hemorrhage  ceased 
I  took  out  as  cleanly  as  possible  the  blood  in  which  the 
bowels  were  completely  enveloped.  Though  I  considered 
the  case  as  nearly  hopeless,  I  advised  the  same  dressings 
and  the  same  regimen  as  in  the  above  case.  She  has  en- 
tirely recovered  from  all  pain  and  pursues  her  ordinary 
occupation. 

In  May,  1816,  a  negro  woman  was  brought  to  me  from  a 
distance.  I  found  the  ovarium  much  enlarged,  and  as  it 
could  be  easily  moved  from  side  to  side,  I  advised  the  ex- 
traction of  it.  As  it  adhered  to  the  left  side  I  changed  my 
plan  of  opening  to  the  linea  alba.  I  began  the  incision, 
in  company  with  my  partner  and  colleague,  Dr.  William 
Coffer,  an  inch  below  the  umbilicus,  and  extended  it  to 
within  an  inch  of  the  os  pubis.  I  then  put  a  ligature 
around  the  Fallopian  tube  and  endeavored  to  turn  out  the 
tumor,  but  could  not.  I  then  cut  to  the  right  of  the  um- 
bilicus, and  above  it  two  inches,  turned  out  a  scirrhous 
ovarium  (weighing  six  pounds),  and  cut  it  off  close  to  the 
ligature  put  around  the  Fallopian  tube.  I  then  closed  the 
external  opening,  as  in  the  former  cases,  and  she  com- 
plaining of  cold  and  chilliness,  I  put  her  to  bed  prior  to 
dressing  her;  then  gave  her  a wineglassful  of  cherry  bounce 
and  thirty  drops  of  laudanum,  which  soon  restoring  her 


262  MCDOWELL'S  OPERATLON 

warmth,  she  was  dressed  as  usual.  She  was  well  in  two 
weeks,  though  the  ligature  could  not  be  released  for  five 
weeks,  at  the  end  of  which  time  the  cord  was  taken  away, 
and  she  now,  without  complaint,  officiates  in  the  laborious 
occupation  of  cook  to  a  large  family. 

As  to  the  estimate  of  the  reports  of  the  above 
cases  of  Dr.  McDowell,  and  the  value  attached 
to  the  results  of  his  three  operations  soon  after 
their  publication,  I  deem  it  of  interest  to  menr 
tion  the  opinions  of  two  physicians,  as  found 
expressed  in  the  Eclectic  Repertory  (1818)  :  one, 
as  a  critic  of  the  operations  of  Dr.  McDowell, 
Dr.  Ezra  Michener,  of  Philadelphia ;  and  the 
other,  Dr.  Thomas  Henderson,  of  Georgetown, 
D.  C;  as  a  defender  of  them. 

Dr.  Michener,  under  the  title  of  a  "  Case  of 
a  Diseased  Ovarium,"1  said  the  diagnosis  was 
not  clear.  He  thought,  however,  the  case  was 
one  of  "ovarium  disease,  but  whether  scirrhous 
or  hydropic,  could  not  so  satisfactorily  deter- 
mine." Dr.  James  was  called  in  consultation, 
and  fully  corroborated  his  opinion.  The  patient, 
Rosanna  Albert,  after  two  prescriptions  of  diu- 
retics for  the  accompanying  dropsical  effusion, 
absolutely  refused  to  take  the  medicines  pre- 
scribed, and  soon  after  died.  At  the  autopsy, 
in  addition  to  an  enlarged  and  scirrhous  state 

o 

1  Op,  cit.,  1818,  vol.  viii.,  p.  242. 


IN  THE  UNITED  STA  TES.  263 

of  the  pancreas,  there  were  "  found  the  uterus 
and  tumor  so  intimately  united  as  to  render  it 
impossible  to  distinguish  or  separate  them"  ;  the 
latter,  when  removed,  weighing  eight  pounds 
and  ten  ounces.  The  fault  Dr.  Michener  found 
with  Dr.  McDowell  was  that  he  told  what 
dropsy  of  the  ovary  was  in  his  first  case,  but 
did  not  make  himself  intelligible  regarding 
"  diseased  ovaria  "  of  a  "  scirrhous  or  hydropic" 
character.     He  adds : 

"  It  is  a  wish  to  give  you  a  counterpart  for  Dr.  McDow- 
ell's paper  that  induces  me  to  offer  this  account  for  your 
disposal. 

"While  his  hand  holds  forth  the  successful  blade  as  an 
ensign  for  the  bold  and  dexterous  surgeon,  may  I  humbly 
point  to  the  dangers  which  lurk  under  the  obscure  and  de- 
lusive indications  of  this  species  of  disease  ? 

"It  is  much  to  be  regretted  that  cases  so  interesting  to 
the  community  as  those  of  Dr.  McDowell,  and  as  novel  as 
interesting,  should  come  before  the  public  in  such  a  man- 
ner as  to  frustrate  the  intention  of  becoming  useful. 

"Far  be  it  from  me  to  arraign  the  probity  of  Dr.  Mc- 
Dowell. If  the  cases  he  relates  are — as  I  sincerely  hope 
them  to  be — correctly  stated,  no  remarks  of  mine  can 
detract  from  his  merit." 

And,  after  criticising  Dr.  McDowell's  opera- 
tions, and  his  descriptions  of  them,  he  concludes 
as  follows  : 

"  The  utter  impossibility  of  our  ever  being  able  to  ascer- 
tain with  certainty  the  real  nature  of  those  internal  diseases, 
the  delusive  nature  of  all  their  indications,  and  the  neces- 


264 


MCDOWELL'S  OPERATLOA 


sary  danger  of  an  operation  under  the  most  favorable  cir- 
cumstances, will  be  likely  to  prove  an  insurmountable 
barrier  to  the  use  of  the  knife  in  their  removal,  as  few  per- 
sons will  be  likely  to  venture  their  reputation  on  such 
uncertain  data." 

Dr.  Henderson,  in  a  paper  entitled  "On 
Ovarian  Disease  and  Abdominal  Steatoma,"1 
read  before  the  Medical  Society  of  the  District 
of  Columbia,  July,  181 8,  takes  just  the  opposite 
view  to  that  of  Dr.  Michener  of  Dr.  McDowell's 
three  reported  cases.  He  refers  to  these  cases 
and  the  operations  performed  by  McDowell,  in 
a  pleasing  and  dignified  manner,  in  connection 
with  the  unsuccessful  treatment  of  his  own  case 
of  steatoma,  and  the  result  of  the  autopsy  that 
followed.  His  patient,  aged  eighteen,  was  a 
negress,  who  came  under  his  observation  in 
October,  18 16,  the  case  then  "  evidently  tending 
to  a  fatal  termination."  Dr.  Cook,  in  a  consul- 
tation, corroborated  Dr.  Henderson's  opinion — 
to  wit,  that  the  tumor  occupied  a  somewhat 
central  position  in  the  abdomen,  was  neither 
connected  with  the  uterus  nor  the  bladder,  and 
that  it  ought  to  be  tapped.  This  operation  was 
performed,  but  no  fluid  was  found,  and  death 
followed  three  weeks  after.  At  the  autopsy  it 
was  found  that — 

1  Op.  cit.,  1818,  vol.  viii.,  p.  545. 


IN  THE  UNITED  STATES. 


265 


"The  tumor  adhered  closely  on  each  side  of  the  edges 
of  the  abdominal  (recti)  muscles,  through  which  it  seemed 
to  have  protruded,  separating  and  throwing  them  to  each 
side,  and  the  investing  membrane  adhered  below  to  the  os 

pubis The  tumor  was  a  steatoma ;  the  suety 

matter  was  contained  in  cysts  of  different  dimensions,  from 
the  size  of  a  grape  to  that  of  a  hen's  egg.  The  color  of 
the  steatoma  was  various,  as  the  size  of  the  cysts  in  which 
it  was  contained  ;  being  in  some  parts  of  the  tumor  of  the 
color  of  coagulated  blood,  and  again  white,  with  all  the 
intermediate  shades. ' ' 

The  tumor  held  no  relations  whatever  with 
either  ovary,  and  weighed  about  nine  pounds. 

"The  right  ovarium,  however,  was  as  large  as  the  gall- 
bladder of  an  adult,  containing  thin  purulent  matter,  and 
almost  full  of  black  hair ;  a  part  of  the  hair  growing  from 
the  internal  surface  of  the  organ,  the  rest  loosely  lying  in 
the  purulent  matter.  The  Fallopian  tubes  in  a  natural 
state." 

Dr.  Henderson,  after  completing  his  remarks 
upon  the  peculiarities  and  the  result  of  his  case 
(the  immediate  cause  of  death  being,  no  doubt, 
septicaemia  following  suppuration  and  rupture 
of  the  small  dermoid  cyst  revealed  by  the 
autopsy),  proceeds  to  comment  upon  Dr.  Mc- 
Dowell's three  cases  in  the  following  manner: 

"  While  I  unite  with  Dr.  Michener  in  expressing  my 
deep  regret  that  a  more  particular  detail  has  not  been  pre- 
sented of  these  remarkable  cases,  yet,  in  one  point  of  view, 
they  are  completely  satisfactory  in  proving  that  an  opera- 
tion may  be  successful  in  cases  which  have,  I  fear,  too  fre- 


266  MCDOWELL'S  OPERATION 

quently  been  allowed  to  proceed  undisturbed  to  a  fatal 
termination.  .  .  .  Let  the  surgeon  reflect  on  the  pro- 
gress that  has  been  made  within  the  last  century  in  dis- 
tinguishing the  seats  and  characters  of  internal  diseases ; 
let  him  contemplate,  too,  the  astonishing  powers  which  the 
constitution  manifests  in  restoration  from  injuries ;  let  him 
exercise  the  same  decision  in  the  use  of  the  knife  which 
Dr.  McDowell  displayed,  and  that  research  in  all  fatal 
cases  which  Dr.  Michener  manifested  in  inquiring  into  the 
cause  and  seat  of  diseases;  and  the  latter  gentleman  will 
probably  live  to  see  the  time  when  he  will  with  pleasure 
acknowledge  the  inapplicability  of  the  views  held  out  in 
the  last  paragraph  (of  his  paper)  to  the  power  of  the  sur- 
geon's discernment  and  the  effect  of  his  knife." 

I  next  present  the  history  of  two  additional 
cases  of  ovariotomy  by  Dr.  McDowell,  which, 
with  the  three  previously  given,  constitute  the 
only  five  cases  published  in  detail.  This  report 
is  communicated  to  Dr.  James,  of  Philadelphia, 
in  the  form  of  a  letter,  with  answers  to  certain 
criticisms  of  Dr.  Michener  as  set  forth  in  the 
remarks  of  Dr.  Henderson  upon  his  cases,  Dr. 
McDowell  not  having  previously  seen  these 
criticisms.  In  the  fact  that  Dr.  Michener  had 
made  such  criticisms  is  no  doubt  to  be  found 
the  explanation  why  Dr.  McDowell  sent  this 
paper  directly  to  Dr.  James,  who  had  seen  Dr. 
Michener's  case  in  consultation,  and  was  then 
a  leading  practitioner  and  teacher  in  Philadel- 
phia. 


IN  THE  UNITED  STATES.  26j 

"Observations  on  Diseased  Ovaria} 
"  By  Ephraim  McDowell,  M.D. 

September,  1819. 
"  Dear  Sir  :  I  am  induced  to  make  this  statement, 
principally  in  consequence  of  the  observations  of  Dr.  Hen- 
derson, which  appeared  in  a  number  of  the  Repertory, 
published  twelve  or  fifteen  months  since,  '  On  Ovarian 
Disease  and  Abdominal  Steatoma.' 

"  Since  my  former  communication  I  have  twice  per- 
formed the  operation  of  excision,  which  cases  are  sub- 
joined." 

There  are  three  points  criticized  by  Dr.  Mich- 
ener :  First,  with  regard  to  the  length  of  the 
incision  made  by  McDowell  in  his  first  case. 
To  this  Dr.  McDowell  replies : 

"As  I  did  not  actually  measure  the  incision,  it  would, 
perhaps,  have  been  better  to  have  said,  an  incision  was 
made,  about  three  inches  to  the  left  of  the  musculus  rectus, 
extending  from  the  margin  of  the  ribs  to  the  os  pubis,  on 
a  woman  whose  abdomen  was  distended  by  a  tumor  to  an 
enormous  size." 

Second,  regarding  the  contused  injury  on  the 
left  side  of  the  abdomen,  attributed  to  the  horn 
of  the  side-saddle,  and  mentioned  by  Dr.  Mich- 
ener  as  being  within  the  field  of  operation,  to 
which  Dr.  McDowell  replies  : 

"  Now,  with  all  due  deference  to  the  Doctor's  knowledge 
in  surgery,  and  the  structure  of  side  saddles,  I  think  it 
would  not  be  difficult  to  conceive  that  a  tumor  weighing 

1  Op.  cit.,  1819,  vol.  ix.,  p.  546. 


268  MCDOWELL'S  OPERATION 

upward  of  twenty  pounds  would  fill  the  whole  abdomen, 
and,  although  attached  to  the  left  ovarium,  the  weight  and 
bulk  must  have  been  almost,  if  not  quite,  as  great  on  the 
right  side  as  on  the  left.  I  would  observe  that  my  patient 
was  a  woman  of  small  stature ;  her  abdomen  had  become 
so  pendulous  as  to  reach  almost  to  her  knees;  the  size  of 
the  tumor  was  ascertained  from  actual  weight.  Had  the 
left  side  of  the  abdomen  been  contused,  I  would  either 
have  delayed  the  operation  until  the  contusion  was  re- 
moved or  operated  on  some  other  part.  I  never  have  been 
of  opinion  that  bruised  flesh  would  heal  so  readily  as  sound, 
which  matter  I  esteem  of  essential  importance  to  success 
in  this  operation." 

Third,  as  to  the  patient's  getting  up  on  the 
fifth  day  and  making  her  bed,  to  which  Dr. 
McDowell  answered  : 

"  The  Doctor's  scepticism  alone  appears  to  have  carried 
him  through  the  statement,  and  I  am  surprised  that  he  will 
even  admit  the  fact  of  her  returning  home,  on  horseback, 
in  five  and  twenty  days  after  the  operation,  a  distance  of 
seventy  miles,  and  in  the  depth  of  winter. " 

Dr.  McDowell  answers,  in  a  general  way, 
other  criticisms,  both  of  Drs.  Michener  and 
Henderson,  by  reference  to  the  qualifications 
of  a  surgeon,  and  his  fitness  for  the  important 
work  usually  expected  of  him.  He  displays  in 
these  remarks  the  keenest  sense  of  honor  and 
the  highest  appreciation  of  his  own  responsi- 
bility in  giving  to  the  profession  the  results  of 
his  experience  in  connection  with  the  operations 
in  question.     He  says  : 


IN  THE  UNITED  STA  TES. 


269 


"  Dr.  Henderson  thinks  I  was  entirely  too  inconsiderate 
in  my  detail  of  the  cases  of  diseased  ovaria ;  I  thought  my 
statement  sufficiently  explicit  to  warrant  any  surgeon's  per- 
forming the  operation  when  necessary,  without  hazarding 
the  odium  of  making  an  experiment ;  and  I  think  my  de- 
scription of  the  mode  of  operating,  and  of  the  anatomy  of 
the  parts  concerned,  clear  enough  to  enable  any  good 
anatomist  possessing  the  judgment  requisite  for  a  surgeon 
to  operate  with  safety.  I  hope  no  operator  of  any  other 
description  may  ever  attempt  it.  It  is  my  most  ardent  wish 
that  this  operation  may  remain,  to  the  mechanical  surgeon, 
forever  incomprehensible.  Such  have  been  the  bane  of  the 
science  ;  intruding  themselves  into  the  ranks  of  the  profes- 
sion, with  no  other  qualification  but  boldness  in  undertak- 
ing, ignorance  of  their  responsibility,  and  indifference  to 
the  lives  of  their  patients;  proceeding  according  to  the 
special  dictates  of  some  author,  as  mechanical  as  themselves, 
they  cut  and  tear  with  fearless  indifference,  utterly  incapa- 
ble of  exercising  any  judgment  of  their  own  in  cases  of 
emergency,  and  sometimes  without  possessing  even  the 
slightest  knowledge  of  the  anatomy  of  the  parts  concerned. 

"The  preposterous  and  impious  attempts  of  such  pre- 
tenders can  seldom  fail  to  prove  destructive  to  the  patient 
and  disgraceful  to  the  science.  It  is  by  such  this  noble 
science  has  been  degraded,  in  the  minds  of  many,  to  the 
rank  of  an  art." 

"  Case  I.  (IV.) — In  April,  181 7,  I  operated  on  a  negro 
woman  from  Garard  County,  extracting  a  scirrhous  ova- 
rium weighing  five  pounds.  The  incision  was  made  near 
the  linea  alba.  As  in  the  cases  formerly  related,  I  tied  a 
cord  firmly  round  the  ligament,  attaching  it  to  the  uterus, 
and  cut  away  the  ovarium ;  but,  owing  to  the  shortness  and 
sponginess  of  the  part,  the  cord  slipped  off  before  I  laid 
the  ovarium  out  of  my  hands,  and  a  profuse  discharge  of 
blood  took  place.  I  immediately  drew  the  uterus  to  the 
external  incision  and  commenced  tying  up  the  bleeding 


2«0  MCDOWELL'S  OPERATION 

mouths  separately.  This  also,  in  consequence  of  the  dis- 
eased state  of  the  parts,  proved  only  of  partial  efficacy,  as 
several  of  the  ligatures  cut  through  on  tying  them.  I  now 
thought  it  all  over  with  my  poor  patient ;  but,  arming  a 
needle  with  a  strong  ligature,  I  passed  it  round  the  liga- 
ment, securing  it  in  its  place  by  taking  several  stitches  over 
its  surface  as  I  passed  it  round,  and  firmly  tied  it.  By 
turning  her  nearly  on  her  stomach,  I  was  able  to  get  most 
of  the  blood  out  of  the  abdomen,  using  my  hand  to  extract 
the  coagulated  portion.  The  incision  was  then  closed  by 
the  interrupted  suture  and  strips  of  adhesive  plaster.  She 
recovered  happily,  but  I  am  told  her  health  is  not  good  ; 
the  account  I  had  of  her  was  awkwardly  given ;  from  what 
I  could  learn  her  complaint  is  hysterical.  This,  though 
the  smallest  ovarium  I  have  ever  extracted,  was  much  more 
troublesome  to  the  patient  than  in  any  previous  case.  Be- 
side experiencing  severe  lancinating  pains  in  the  parts,  she 
was  seldom  able  to  discharge  her  urine  without  getting 
almost  on  her  head,  in  consequence  of  the  tumor  falling 
down  into  the  pelvis  and  compressing  the  urethra." 

"  Case  II  (V). — A  negro  woman  from  Lincoln  County 
was  brought  to  me  in  April,  1818,  supposed,  by  the  differ- 
ent physicians  who  had  attended  her,  to  be  affected  with 
ascites ;  she  had  been  under  their  care  about  eighteen 
months.  On  examining  her  I  could  very  plainly  discover 
the  fluctuation  of  fluid  in  the  abdomen,  and  for  some 
months  administered  medicine  for  ascites,  without  effect ; 
despairing  of  the  power  of  medicines,  I  at  length  tapped 
her,  and  discharged  thirteen  quarts  of  gelatinous  fluid,  such 
as  I  had  before  met  with  in  dropsical  ovaria,  of  so  thick  a 
consistence  that  I  found  it  extremely  difficult  and  tedious 
to  discharge  it.  In  two  months  after  I  found  it  necessary 
to  tap  again  ;  during  the  process  of  discharging  it  a  second 
time  the  opening  was  frequently  stopped  by  viscid  portions 
of  the  jelly,  which  were  broken  by  introducing  a  probe ; 
when  the  abdomen  was  pretty  well  evacuated  I  discovered, 


IN  THE  UNI2ED  STATES. 


271 


with  the  probe,  a  firm  substance,  which,  on  minute  exami- 
nation, I  found  to  be  of  considerable  size.  I  at  once  sup- 
posed the  existence  of  dropsical  ovarium,  in  which  I  was 
confirmed  on  finding  the  uterus  empty  by  examination  per 
vctginam.  Some  months  after  she  was  again  tapped,  at 
which  time  I  made  the  opening  large  enough  to  admit  my 
finger,  by  which  means  I  was  able  to  ascertain  the  nature 
of  the  disease  beyond  a  doubt.  I  informed  her  master 
what  was  certainly  her  situation,  and  that  nothing  but  ex- 
cision could  effect  a  cure.  My  advice  was  not  immediately 
followed,  nor  until  after  she  was  tapped  a  fourth  time,  a 
week  or  two  after  which  she  was  brought  to  Danville  to 
"undergo  the  operation,  which  was  performed  May  11,  1819. 
The  diseased  ovarium  being  on  the  left  side  and  evidently 
dropsical,  the  incision  was,  of  course,  made  on  the  left  side. 
On  exposing  the  tumor  it  was  found  to  adhere  to  the 
parietes  of  the  abdomen  and  to  the  intestines  by  slender 
cords,  which  were  easily  separated  with  the  hand  and 
which  caused  a  slight  effusion  of  blood.  To  the  uterus  two 
strong  ligaments  adhered ;  one,  the  natural  ligament,  attach- 
ing the  ovarium  to  the  uterus ;  the  other,  an  artificial  one, 
attached  to  the  fundus  uteri,  which  appeared  to  be  com- 
posed of  the  above-mentioned  slender  cords  compacted 
together.  I  then  tied  fine  cords  of  silk  firmly  round  each 
of  these  ligaments,  discharged  the  contents  of  the  tumor, 
and  cut  it  away. 

"  There  were  sixteen  quarts  of  gelatinous  fluid  discharged 
from  the  tumor  and  abdomen.  The  dressings  and  precau- 
tions were  the  same  as  in  other  cases.  The  second  day 
after  the  operation  she  was  affected  with  violent  pain  in  the 
abdomen,  together  with  an  obstinate  vomiting.  She  was 
blooded  as  copiously  as  her  strength  would  allow,  but 
without  producing  any  abatement  of  the  pain  or  vomiting. 
On  the  third  day  she  died.  On  examination  after  death 
the  uterus,  contrary  to  expectation,  appeared  natural  and 
uninflamed,  the  right  ovarium  healthy,  the  silken  cords 
were  securely  and   properly  fixed,  and  not  in  a  situation 


2^2  MCDOWELL'S  OPERATLON 

likely  to  injure  the  adjoining  parts.  Her  death  had  pro- 
ceeded from  peritoneal  inflammation.  This  membrane, 
throughout  its  whole  extent,  appeared  greatly  inflamed, 
and  the  intestines  largely  inflated. 

"  I  was  assisted  in  this  operation  by  my  nephew,  Dr. 
William  A.  McDowell;  Drs.  Weizegar,  Tomlinson,  and 
Horr  were  present. 

"On  examining  the  substances  we  had  removed,  the 
contents  of  the  sac  presented  a  variety ;  different  portions 
of  the  fluid  were  of  different  colors — semi-transparent, 
white,  brown,  and  yellow.  There  was  also  contained  in 
the  sac  a  considerable  quantity  of  hair,  which  grew  from 
the  inner  surface.  Enveloped  in  the  inner  substances  of 
the  sac  we  found  a  bone,  resembling  very  much  in  shape 
the  front  tooth  of  a  cow. 

"From  the  circumstances  of  the  hair  and  bone  one  or 
two  of  the  physicians  present  were  inclined  to  believe  the 
disease  originated  from  an  extra-uterine  conception,  and 
that  all  of  the  foetus  had  been  absorbed,  save  the  hair  and 
single  bone,  which  was  found.  This  question  I  submit  to 
the  faculty.  As  for  myself,  I  think  it  is  as  reasonable  to 
suppose  the  hair  and  bone  in  this  unnatural  situation  was 
the  result  of  a  morbid  action.  She  had  been  delivered  of 
a  child  two  years  before  the  operation ;  her  health  during 
that  time  was  never  good,  but  she  had  no  reason  to  believe 
herself  pregnant;  and  if  it  were  the  case,  I  doubt  whether 
a  whole  foetus  could  be  so  nearly  absorbed  in  two  years. 
There  was  likewise  a  round  hole  in  the  sac  which,  from  the 
level  appearance  of  its  edges,  appeared  of  long  standing ; 
the  hole  was  about  the  size  of  a  musket  ball,  and  there  is 
no  doubt  that  the  gelatinous  fluid  escaped  through  this 
aperture  into  the  abdomen.  This  ovarium,  when  brought 
into  view,  was  of  a  large  size,  which  is  the  more  remark- 
able when  we  consider  the  enormous  quantity  of  fluid  which 
had  been  drawn  off  at  different  times  by  the  operation  of 
paracentesis  abdominis.  During  the  evacuation  a  bandage 
was  kept  bound  tightly  around  the  abdomen,  and  consid- 


IN  THE  UNITED  STATES.  273 

erable  pressure  was  made  with  the  hands,  in  order  to  evacu- 
ate its  whole  contents.  In  an  attempt  to  draw  off  the 
contents  of  such  a  tumor  with  a  trocar  it  would  be  impos- 
sible to  perforate  all  the  vesicles,1  and  such  only  as  were 
pierced  would  discharge  their  contents.  While  one  por- 
tion of  the  vesicles  of  the  ovaria  would  discharge  themselves 
into  the  abdomen  another  portion  would  remain  diseased 
in  the  original  way,  thus  compounding  in  the  system  two 
of  the  most  deplorable  diseases  to  which  it  is  liable. 

"Ephraim  McDowell. 
"Dr.  James." 

Comments  :  Recognizing-  the  two  divisions  of 
the  abdomen  (the  lower  and  upper),  formed  by 
a  line  running  across  the  axis  of  the  body  at  the 
umbilicus,  the  reader  will  be  better  prepared 
to  appreciate  the  distinctive  features  of  the 
author's  procedure  in  his  first  case,  based  upon 
his  long  incision  ;  his  exposure  to  the  fullest 
extent  possible  of  the  peritoneal  cavity  ;  and 
his  successful  extirpation  of  the  diseased  ovary 
found  to  exist.  This  incision  was  made  in  both 
the  lower  and  upper  divisions  of  the  abdomen, 
external  to  and  parallel  with  the  left  rectus 
muscle,  being  in  contravention  to  the  old 
method  of  incisionism  restricted  simply  to  the 
lower  division  of  the  abdomen.     Through  the 

1  "That  this  is  the  structure  of  diseased  ovaria,  I  infer,  both 
from  authorities,  and  from  the  difficulty  in  discharging  their 
contents.  I  have  always  been  under  the  necessity  of  intro- 
ducing my  hand  and  raking  it  forth,  the  obstacle  to  the  dis- 
charge being  always  a  membranous  structure." 


274  MCDOWELL'S  OPERATION 

opening  thus  made,  he  applied  a  ligature  around 
the  pedicle  of  the  tumor,  laid  the  latter  open, 
cut  it  away,  and  then,  bringing  the  two  ends  of 
the  ligature  out  at  the  lower  angle  of  the  wound, 
closed  this  up  with  sutures  and  adhesive  strips, 
completing  the  dressing  with  compress  and 
roller.  This  was  the  first  departure  that  had 
ever  been  made  from  the  old  procedure  of  inci- 
sionism  based  upon  the  principle  of  simply 
opening  the  peritoneal  cavity  and  the  tumor 
jointly,  and  then,  after  evacuating  the  contents 
of  the  cyst,  inducing  inflammation,  suppuration 
and  obliteration  of  its  cavity  through  drainage 
and  injections. 

The  author  in  his  five  cases  established  seve- 
ral other  distinctive  and  important  principles  of 
practice.  In  addition  to  the  safety,  and  conse- 
quently the  value,  of  his  long  incision  extended 
from  the  lower  to  the  upper  division  of  the 
abdomen,  and  the  complete  exposure  of  the 
peritoneal  cavity,  combined  with  the  practica- 
bility of  a  completed  method  of  operating  for 
the  extirpation  of  a  diseased  ovary  of  what- 
soever character,  the  several  principles  above 
alluded  to  may  be  set  forth  in  a  general  way  : 
The  introduction  of  one  or  both  hands  for  the 
manipulation  of  the  tumor  and  the  searching 


IN  THE  UNITED  STATES.  2y$ 

for  and  breaking  up  of  adhesions  when  present ; 
the  modified  restriction  of  his  long  incision  to 
the  medium  or  short  in  the  lower  division  of  the 
abdomen,  admitting  one  hand  or  one  finger  for 
whatsoever  purposes,  described  in  his  third  and 
fifth  cases;  the  principle  of  making  a  long 
incision  admitting  one  or  both  hands  for  com- 
pleting the  diagnosis  as  to  the  character  of  a 
fibrous  growth  of  the  uterus,  as  in  the  second 
case;  the  practicability,  after  discovering,  as 
in  the  same  case,  that  the  tumor  could  not  be 
safely  removed,  of  puncturing  and  emptying 
the  principal  cyst  in  it,  from  which  a  cure 
resulted;  the  turning  of  the  patient  upon  the 
left  side,  and  even  upon  the  stomach,  as  in  the 
first  and  fourth  cases,  to  facilitate  the  emptying 
of  the  fluids  out  of  the  cyst  and  the  peritoneal 
cavity,  in  order  to  avoid  rough  handling  of  the 
peritoneum;  the  principle  of  putting  the  liga- 
ture around  the  pedicle  before  puncturing  or 
removing  the  tumor  from  the  abdomen — a  line 
of  practice  doubtless  resulting  from  fear  of 
hemorrhage  by  opening  the  cyst  first;  the 
principle  of  bringing  the  two  ends  of  the  liga- 
ture out  in  the  lower  angle  of  the  wound  at  the 
time  of  closure,  to  facilitate  its  speedy  escape 
from  the  peritoneal  cavity  as    a  foreign    sub- 


2y6  MCDOWELL'S  OPERATLON 

stance,  either  spontaneously  or  by  traction 
upon  it  from  time  to  time.  In  the  fourth  case 
(unquestionably  a  fibrous  growth  of  the  uterus) 
the  author  witnessed,  for  the  first  time,  the  acci- 
dent of  the  ligature  slipping  off  the  pedicle 
because  of  its  shortness,  and  the  danger  result- 
ing therefrom,  which  he  successfully  overcame 
by  an  impromptu  procedure,  combined,  it  is 
inferred,  with  cutting  off  the  ends  of  the  liga- 
tures close  to  the  knots.  In  the  fifth  case,  after 
a  third  tapping,  he  established  the  precedent  of 
a  short  exploratory  incision,  admitting  one  fin- 
ger, to  complete  his  diagnosis.  In  the  same 
case  he  established  a  second  precedent,  after 
removal  of  a  dermoid  cyst,  by  employing  the 
intra-peritoneal  treatment  of  the  pedicle  ;  and 
although  the  patient  died  on  the  third  day,  he 
found  at  the  autopsy  his  "  fine  cords  of  silk" 
"properly  fixed  and  not  in  a  situation  likely  to 
injure  the  adjoining  parts" — a  description 
clearly  showing  that  the  ligature  had  been  cut 
off  with  the  pedicle,  and  left  to  its  chances  of 
absorption.  The  closure  of  the  wound  of  the 
abdomen,  as  in  the  first  case,  with  interrupted 
sutures,  together  with  broad  adhesive  strips, 
compress  and  roller,  and  the  "  observance  of 
the  antiphlogistic  regimen,"  all  indicate  impor- 


IN  THE  UNITED  STA  TES.  277 

tant   principles  of  practice    pursued   in   these 
cases. 

This  concludes  Dr.  McDowell's  five  cases, 
believed,  as  previously  stated,  to  be  the  only 
ones  published  by  him  in  detail ;  but  there  is  no 
doubt  that  he  operated  upon  other  cases,  and 
this  claim  rests  on  the  indisputable  authority  of 
the  late  Prof.  S.  D.  Gross.  In  the  "Report  on 
Kentucky  Surgery,"  which  he  presented  to  the 
Kentucky  State  Medical  Society,  October,  1852, 
Dr.  Gross  states  that  the  whole  number  of 
cases  operated  upon  by  Dr.  McDowell  is  not 
positively  known,  but  from  what  he  has  been 
able  to  learn  directly  from  his  nephew,  Dr.  Wm. 
A.  McDowell  (formerly  of  Louisville),  he  per- 
formed the  operation,  from  first  to  last,  thirteen 
times.  Dr.  Gross,  however,  credits  him  with 
only  three  additional  cases  besides  the  five 
above  presented,  making  in  all  eight  (four 
white  and  four  negro  women).  These  last 
three  cases  (all  in  white  women),  the  particu- 
lars of  which  Dr.  Gross  learned  from  direct 
and  trustworthy  sources,  all  belong  to  the  period 
of  the  first  seven  years,  extending  from  18 19 
to  1826,  inclusive,  which  followed  the  date  of 
Dr.  McDowell's  last  publication.  Their  histo- 
ries are  herewith  given  [n  chronological  order. 


2?8 


MCDO WELL'S  OPERA  TION 


Case  VI. — Mrs.  O.,  of  Nashville,  Tennessee,  aged  fifty- 
five,  and  inclined  to  corpulency.  She  first  noticed  (De- 
cember, 1 82 1)  on  the  left  side  and  a  little  below  the 
umbilicus,  a  small  globular  tumor,  movable  from  side  to 
side,  as  well  as  from  above  downward,  destitute  of  sensi- 
bility, and,  up  to  this  stage  of  the  growth,  attended  with 
but  little  inconvenience.  The  following  summer,  however 
(1822),  there  was  considerable  augmentation  in  the  volume 
of  the  growth,  with  corresponding  increase  of  discomfort, 
and  Dr.  McDowell  was  requested  to  visit  the  patient  at  her 
home  by  her  family  physician,  Dr.  James  Overton. 

Dr.  McDowell,  after  a  careful  examination  of  the  case, 
decided  upon  an  operation  for  the  removal  of  the  tumor. 
He  cautiously  made  his  medium  incision  in  the  linea  alba 
below  the  umbilicus  and  over  the  most  prominent  part  of 
the  growth,  intending  to  extend  this  into  his  long  incision 
above  the  umbilicus  in  order  to  facilitate  the  different 
steps  of  the  operation.  In  this,  however,  he  was  disap- 
pointed, "  for  he  had  no  sooner  made  his  first  incision 
through  the  peritoneum  than  there  gushed  out,  in  a  full 
stream,  a  bloody-looking  serum,  which  continued  to  flow 
till  the  sac  which  had  contained  it  was  apparently  entirely 
empty.  The  quantity  thus  lost  was  about  one  gallon." 
Judging  that  the  character  of  the  tumor  and  its  surround- 
ings were  unfavorable  for  removal,  he  made  no  further 
attempt  to  complete  the  operation,  but  closed  the  incision, 
leaving  a  tent  in  its  lower  extremity  to  insure  drainage. 
"The  patient,  who  lived  from  fifteen  to  twenty  years  after 
the  operation,  enjoyed  excellent  health."  The  details  of 
the  after-treatment  of  the  operation  were  furnished  Dr. 
Gross  by  Dr.  Overton. 

As  an  interesting  incident  connected  with  the 
operation  in  this  case,  and  referred  to  by  Dr. 
Gross,  may  be  noted  the  presence  of  General 
Andrew  Jackson,  before  he  was  President,  "a 


IN  THE  UNITED  STATES.  27Q 

neighbor  of  the  patient,  who  assisted  in  holding 
her  hands  and  supporting  her  resolution." 

Case  VII. — Miss  Plasters,  May,  1823.  The  circum- 
stances attending  this  case  were  furnished  Dr.  Gross  by 
Dr.  W.  C.  Gait,  of  Louisville,  Kentucky,  and  were  con- 
tained in  a  letter  received  by  the  latter  from  Dr.  McDowell. 
An  abstract  of  the  case  from  Dr.  Gross's  report  is  here  pre- 
sented. When  the  patient  reached  Danville  to  consult  Dr. 
McDowell  the  tumor  was  found  to  fill  the  entire  abdominal 
cavity,  although  it  had  been  tapped  only  three  months 
previously.  She  was  so  extremely  debilitated  that  he  be- 
lieved she  would  hardly  be  able  to  sustain  the  shock  of  the 
operation.  After  a  few  days  rest,  however,  he  proceeded 
to  make  his  usual  long  incision,  extending  the  whole  length 
of  the  lineaalba,  and  removed  the  tumor  without  difficulty. 
The  pedicle  was  tied  and  the  wound  carefully  closed  in  the 
usual  manner.  Recovery  followed.  The  patient  duly 
regained  her  usual  good  health  and  spirits  and  the  follow- 
ing spring  (April,  1824)  "engaged  herself  to  marry." 

Case  VIII.— Mrs.  Delano,  of  Chillicothe,  Ohio  (1826), 
aged  thirty-eight.  Her  case  will  also  be  presented  in  ab- 
stract from  Dr.  Gross's  report.  She  first  noticed  a  fullness 
in  the  right  side  of  her  abdomen  in  the  autumn  of  1822. 
In  December,  1825,  it  is  stated  "a.  hard  tumor  was  dis- 
covered in  the  right  ilio-hypogastric  region  which  has 
steadily  increased  in  volume  and  now  occupies  the  whole 
abdominal  cavity,  from  the  pubic  symphysis  to  above  the 
umbilicus,  reaching  outwardly  as  far  as  the  costal  cartilages. 
It  is  hard,  irregular,  slightly  movable,  and  cannot  be 
traced  under  the  ribs."  The  above  notes  were  made  by 
the  late  Dr.  Daniel  Drake,  of  Cincinnati,  October  24, 
1826,  when  the  patient  was  on  her  way  to  Danville  to  con- 
sult Dr.  McDowell.  On  her  arrival  there,  and  after  a 
thorough  examination  of  her  case,  Dr.  McDowell  thought 
it  possible  to  remove  the  tumor,  notwithstanding  his  belief 


28o  MCDOWELL'S  OPERATION 

that  extensive  adhesions  existed.  He  accordingly  made 
•  his  usual  long  incision  through  the  linea  alba,  and  exposed 
the  tumor,  which  had  firm  adhesions  with  the  omentum. 
After  fully  opening  the  peritoneal  cavity  he  found  the  ad- 
hesions even  more  extensive  than  he  had  at  first  supposed. 
By  the  time  he  had  gotten  the  omentum  separated  the 
patient  became  so  exhausted  that  the  operation  had  to  be 
suspended,  and  finally  it  was  abandoned  altogether.  The 
wound  was  immediately  closed  up,  and  in  about  two  weeks 
it  had  entirely  healed,  the  patient's  general  condition 
seeming  to  be  very  much  the  same  as  it  was  before  the 
operation.  Dr.  Drake  saw  this  woman  the  following  March 
(1827)  and  "  found  her  excessively  emaciated,  with  swell- 
ing of  her  right  leg,  and  all  the  symptoms  of  gradual  ex- 
haustion." Death  took  place  soon  afterward.  No  autopsy 
was  made. 

Out  of  the  author's  8  operations  reported  by 
him  (4  in  white  and  4  in  negro  women),  5  were 
completed,  and  3  were  unfinished,  but  recov- 
ered. Of  the  5  completed  operations  there 
were  2  in  white  and  3  in  negro  women,  with  1 
death  among  the  latter.  Mortality  of  completed 
operations,  20  per  cent. 

Further  Comments. — In  the  reports  of  these 
eight  cases,  four  in  white  and  four  in  negro 
women,  the  fact  of  the  equal  liability  of  the.  two 
races  to  ovarian  tumors  (which  the  author's  ex- 
perience proved)  is  brought  to  light,  probably 
for  the  first  time.  The  pfeneral  belief  of  the 
profession  now,  however,  is  that  the  liability  to 
ovarian  tumors  is  largely  in  favor  of  the  white 


IN  THE  UNITED  STATES.  28l 

race,  and  vice  versa,  to  fibroid  tumors  in  favor 
of  the  black  race.  This  experience  of  the  author 
regarding  the  general  character  of  the  tumors 
in  these  cases  (treated  at  a  time  when  fibrous 
growths  were  generally  regarded  as  scirrhous 
growths)  may  be  explained  or  reconciled  with 
our  present  views  on  the  supposition  of  his 
erroneous  diagnosis  in  some  of  the  cases  he 
operated  upon,  especially  in  those  of  negresses. 
One  of  these  cases,  the  second  of  the  series, 
was  certainly  an  interstitial  or  a  sessile  fibrous 
growth  of  the  uterus  ;  and  there  is  but  little 
doubt  that  the  third  and  fourth  cases  were  of 
the  pedunculated  variety  of  the  same.  As  to 
the  remaining  one,  the  fifth  case,  the  tumor 
was  unquestionably  a  dermoid  cyst,  a  diagnosis 
which  accords  fully  with  the  author's  "history  of 
the  case  and  the  graphic  description  of  his 
operation,  as  well  as  with  the  general  character 
of  the  specimen  removed.  Of  the  sixth  case 
enough  has  been  said  to  convince  any  one 
familiar  with  the  subject  that  the  tumor  found 
was  a  fibroid  growth  of  the  uterus  and  that 
ascites  had  resulted  from  the  irritation  of  the 
peritoneum  caused  by  it.  The  patient  remained 
well  or  comfortable  for  fifteen  or  twenty  years 
after  the  operation,  thus  proving  that  the  empty- 


282  MCDOWELL'S  OPERATION 

ing  and  draining  of  the  peritoneal  cavity  was 
more  or  less  curative,  contrary  to  the  result 
that  would  have  followed  had  the  tumor  been 
ovarian.  The  seventh  case  was  unquestionably 
one  of  ovarian  tumor,  and  presented  nothing 
unusual  in  the  result  of  the  operation  further 
than  the  proving  of  the  safety  and  value  of  the 
long  incision.  In  the  eighth  case  the  tumor,  if 
not  a  fibrocystic  of  the  uterus,  was  probably  a 
dermoid  cyst,  complicated,  as  was  found,  with 
extensive  adhesions.  This  operation  was  per- 
formed only  four  years  before  the  author's  death 
(1826),  and  there  is  no  evidence,  as  far  as  the 
study  of  the  subject  goes,  to  show  that  he  ever 
undertook  another  operation  after  the  date  of 
this  one. 

The  significance  of  the  facts  brought  out  is 
that  the  tumors  in  the  two  successful  cases  in 
negresses  (Cases  III.  and  IV.)  were  peduncu- 
lated growths  of  the  uterus,  involving  greater 
difficulties  in  the  operations,  which  consequently 
augment  in  a  corresponding  degree  the  statisti- 
cal value  of  the  author's  success.  In  Case  IV. 
the  pedicle  was  so  short  that  the  ligature  slipped 
off  after  it  was  tied,  resulting  in  great  loss  of 
blood  before  another  could  be  applied  and 
secured. 


IN  THE  UNITED  STATES.  283 

As  regards  a  most  embarrassing  difficulty 
encountered  in  Case  I.,  it  may  be  remembered 
that  the  intestines  protruded  from  the  abdominal 
cavity,  and  remained  out  of  the  body  twenty-five 
minutes,  or  until  the  pedicle  could  be  tied  and 
the  tumor  laid  open  and  emptied.  Again,  as 
an  incident  in  the  after-treatment  of  this  case, 
it  will  be  recalled  that  the  author  at  his  visit  on 
the  fifth  day  found  the  patient  up  and  making 
her  bed.  With  such  imprudence  and  disregard 
of  ordinary  judgment  on  her  part  it  was,  there- 
fore, only  by  mere  accident  or  "  good  luck  "  that 
the  immense  importance  of  this  first  success  was 
not  lost  to  science  and  humanity.  In  the  only 
case  (V.)  in  which  death  resulted  a  dermoid 
cyst  was  found,  with  the  usual  complications  in 
such  cases  from  repeated  tappings — viz.,  numer- 
ous and  strong  adhesions.  At  the  time  of  the 
operation  the  patient  had  undergone  four  tap- 
pings, and  her  general  condition  of  health  was 
much  depreciated.  Extensive  parietal  and  intes- 
tinal adhesions  had  to  be  broken  up  and  several 
bleeding  vessels  had  to  be  tied,  so  that  peri- 
tonitis supervened,  from  which  death  resulted 
on  the  third  day.  Such  a  result  was  to  be 
expected. 

Of  the  three  unfinished  operations  but  little 


284 


MCDOWELL'S  OPERATLON 


is  to  be  said  further  than  that  the  abdomen  was 

opened  and  the  removal  of  tumor  found  to  be 

impossible.     It  is  clear  enough  to  the  mind  of 

the  reader  that  the  tumors  in  Cases  II.  and  VI. 

were  uterine ;  and,  as  to  Case  VIII.,  it  presented 

complications  of  the  gravest  character,  as  shown. 

Case  IX. — Entitled :  "  Case  of  Ovarian  Dropsy  Suc- 
cessfully Removed  by  a  Surgical  Operation,"  by  Dr.  Na- 
than Smith,1  of  Connecticut,  Professor  of  Physic  and 
Surgery  at  Yale  College.  Mrs.  Strowbridge,  of  Norwich, 
Vermont,  aged  thirty-three,  consulted  Dr.  Smith  regarding 
an  enlargement  in  her  right  side,  which  she  first  noticed 
when  it  was  about  the  size  of  a"  goose  egg,''  seven  years 
previously.  She  had  born  five  children.  The  small  en- 
largement excited  her  attention  just  after  the  birth  of  the 
first,  and  her  application  for  treatment  occurred  about  ten 
months  after  the  birth  of  the  last.  Dr.  Smith's  diagnosis 
was  that  the  enlargement  proceeded  from  ovarian  dropsy, 
and  he  believed  the  case  to  be  favorable  for  an  operation, 
involving  extirpation  of  the  diseased  organ.  Accordingly, 
after  the  necessary  preparations,  he  proceeded  to  perform 
it  in  the  presence  of  Drs.  Lewis,  Mussey,  Dana,  and  Hatch, 
July  5,  1821.  Hesays:  "  I  commenced  an  incision  below 
the  umbilicus  directly  in  the  linea  alba,  and  extended  it 
downward  three  inches,"  which  exposed  the  tumor.  He 
then  punctured  the  cyst  (which  proved  to  be  single)  with 
a  trocar,  and  drew  off  eight  pounds  of  a  "dark-colored 
ropy  fluid."  Next,  the  sac  was  seized  and  traction  made 
upon  it.  This  brought  to  light  some  slight  omental  ad- 
hesions, which  were  separated  with  the  fingers  and  knife. 
"  By  continuing  to  pull  out  the  sac  the  ovarian  ligament 
was  brought  out ;  this  was  cut  off.  Two  small  arteries 
secured  with  leather  ligatures,  and  the  ligament  was  then 

1  Am.  Med.  Recorder,  vol.  v.,  p.  124,  1822. 


IN  THE  UNITED  STATES. 


285 


returned,"  the  ligatures  being  cut  off  close  to  the  knots. 
The  fluid  drawn  off  weighed  eight  pounds,  and  the  empty 
cyst  from  "two  to  four  ounces."  No  sutures  were  used 
for  closing  the  wound,  only  adhesive  strips  and  bandage 
being  employed  for  the  purpose.  Patient  completely 
recovered. 

Dr.  Smith  states  that  he  was  led  to  perform 
the  above  operation  from  the  fear  the  patient 
had  of  a  speedy  death  from  the  growth  of  the 
tumor,  and  from  the  fact  that  he  had  learned 
from  an  autopsy,  and  from  several  specimens  of 
dropsical  ovaries  in  his  possession,  that  adhe- 
sions were  absent,  or  so  slight  as  to  be  of  no 
practical  consequence  in  an  operation  for  re- 
moval. He  further  states  that  "  the  operation 
pursued  in  the  above  case  is  the  same  as  I  have 
described  to  my  pupils  in  several  of  my  last 
courses  of  lectures  on  surgery.  The  result  has 
justified  my  previous  opinions."  Dr.  Smith,  in 
this  connection,  refers  in  a  foot-note  to  the  trans- 
lation and  publication1  of  the  views  of  Professor 
Dzondi,  of  Germany,  relating  to  his  treatment 
of  ordinary  encysted  dropsy  by  puncture  and 
incision,  followed  by  the  use  of  a  tent  with  the 
expectation  of  causing  mortification  and  slough- 
ing of  the  cyst  walls,  and  thus  favoring  their 
escape  through  the  wound,  either  spontaneously 

1  Op.  Cit.,  vol.  iii.,  p.  63. 


286  MCDOWELL'S  OPERATLON 

or  by  the  use  of  a  broad-beaked  forceps.  He 
says  he  did  not  read  this  article  until  after  his 
operation.  In  a  foot-note1  published  in  Dr. 
Smith's  Medical  and  Surgical  Memoirs  by  the 
editor,  his  son,  Dr.  Nathan  R.  Smith,  of  Balti- 
more, are  to  be  found  the  following- statements: 

"  Before  the  extirpation  of  the  ovarian  tumor  was  accom- 
plished by  Professor  Smith,  as  related  in  the  foregoing 
pages,  the  same  operation  had  been  performed  successfully 
in  Germany.  (Here  referring,  no  doubt,  to  Dr.  Chrys- 
mar's  operations  in  Wurtemberg,  1819-20,  by  McDowell's 
long  incision.)  Of  this,  however,  he  had  no  knowledge, 
and  the  operation  was,  therefore,  with  him  altogether 
original.  As  such  it  must  certainly  be  acknowledged  to 
be  one  of  the  boldest  achievements  of  modern  surgery." 

In  the  same  publication,  and  on  the  same 
authority,  Professor  Smith  is  credited  with  two 
other  cases  "in  which  he  attempted  the  opera- 
tion but  was  compelled  to  desist."  The  first 
case  referred  to  was  that  of  a  fibrous  growth  of 
the  uterus,  and  in  the-  second  the  tumor  was 
doubtless  an  ovarian  cyst  completely  filling  the 
abdominal  cavity.  The  latter  patient  had  been 
tapped  two  or  three  times  previously.  The 
adhesions  were  found  so  extensive  and  firm  that 
the  operation  had  to  be  abandoned.  In  both 
instances    recovery   followed   these    unfinished 

1  Dr.  Nathan  Smith's  Medical  and  Surgical  Memoirs,  p.  230, 
1831. 


IN  THE   UNITED  STATES.  2%7 

operations.       The    editor    thus    concludes    his 
remarks  : 

"  I  ought  here  to  state  that  the  same  operation  has  been 
performed  in  this  country  in  several  instances  by  Dr.  Mc- 
Dowell, of  Kentucky,  and  more  recently  by  others.  I  am 
not  confident  that  the  first  operation  by  Dr.  McDowell  was 
subsequent  to  that  of  my  father. ' ' 

The  late  Dr.  E.  R.  Peaslee1  (Dartmouth  Col- 
lege, February,  1851),  in  the  report  of  his  first 
case  of  ovariotomy — one  of  double  ovarian 
dropsy — concludes  with  the  following  comments 
upon  the  case  of  Professor  Smith  : 

"  Note. — It  is  a  fact,  certainly  not  without  interest,  that 
the  first  patient  on  whom  the  operation  of  ovariotomy  was 
performed  in  this  country  was  an  aunt  of  Miss  G.  (though 
"by  marriage  only),  whose  case  has  just  been  detailed.  The 
operation  alluded  to  (being  the  minor  operation)  was  per- 
formed on  the  5th  of  July,  1820,  by  Dr.  Nathan  Smith, 
Professor  of  Surgery  in  Dartmouth  College,  and  was  suc- 
cessful. The  patient  was  a  Mrs.  Strobridge,  of  Norwich, 
Vermont,  aet.  thirty-three. 

"  For  an  account  of  the  case  see  Medical  and  Surgical 
Memoirs,  by  Nathan  Smith,  M.D.,  Baltimore,  1831. 

"  Th&  year  is  singularly  enough  omitted  in  the  report  of 
the  case.  I  have  ascertained  of  Dr.  H.  Hatch,  of  Burling- 
ton, Vt.,  who  was  present  at  the  operation,  that  it  was  per- 
formed thirty  years  ago  last  July. — E.  R.  P." 

From  the  foregoing  foot-note  it  is  evident 
that  Dr.  Peaslee  quoted  from  Professor  Smith's 

1  Am.  Journ.  Med.  Sciences,  1851,  vol.  xxi.',  p.  321. 


288  MC  DO  WELL'S  OPERATION. 

Memoirs,  and  not  from  his  first  report  of  the 
case  published  in  the  Journal  cited  (1822),  two 
years  after  Dr.  Chrysmar's  three  reported  cases 
in  Germany. 

Results. — One  completed  operation  with  one 
cure,  and  two  unfinished  operations  with  re- 
covery. 

Comments. — The  author  certainly  describes 
a  plain,  simple,  and  unquestionably  successful 
operation,  the  distinctive  features  of  which  would 
seem  at  first  sight  to  be  new  and  original.  The 
claim  of  originality  by  the  author,  however,  does 
not  rest  upon  the  first  direct  and  successful  ex- 
tirpation of  a  dropsical  ovary  without  regard  to 
previous  growth,  character,  or  complications, 
as  has  been  supposed,  but  upon  his  first  suc- 
cessful employment  of  an  old  proposal  restricted 
to  a  short  incision,  a  small  tumor  of  recent  or 
simple  growth,  puncture  of  the  affected  organ, 
and  reduction  of  its  size  in  the  abdomen  with 
extirpation  afterward,  if  possible.  In  the  com- 
bination, therefore,  of  these  several  steps  is 
(seen  the  revival  and  remodeling  of  the  proposal 
referred  to,  embodying  the  practical  extirpation 
of  a  previously  punctured  dropsical  ovary  of 
small  size  and  uncomplicated  surroundings  ;  and 
upon  this  the  author's  claim  of  originality  or, 


IN  THE  UNITED  STATES.  289 

more    properly    speaking,    of    priority    mainly 
turns. 

The  short  incision  now  practically  applied  by 
the  author  for  the  first  time  for  the  accomplish- 
ment of  all  these  ends  in  the  favorable  class  of 
cases  named  was  a  theoretical  proposition  of 
Dr.  William  Hunter,  as  an  extension  of  the  old 
method  of  incisionism  in  the  lower  division  of 
the  abdomen  (1757).  The  proposal,  however, 
failed  to  find  a  supporter  for  about  sixty-four 
years,  when  it  was  revived  and  reduced  to  prac- 
tice by  the  author  in  the  way  above  stated 
(182 1 );  this  being  twelve  years  after  the  de- 
monstration by  McDowell  of  his  first  direct 
extirpation  of  a  dropsical  ovary  by  the  long 
incision  made  in  both  the  lower  and  upper 
divisions  of  the  abdomen  without  regard  to  pre- 
vious growth,  character  or  complications  of  the 
existing  tumor  (1809).  The  ligation  of  the 
arteries  separately  in  the  pedicle,  the  use  of 
leather  ligatures,  and  the  cutting  off  of  the  ends 
of  the  same  close  to  the  knots,  together  with  the 
dropping  of  the  divided  pedicle  into  the  perito- 
neal cavity,  are  principles  of  secondary  import- 
ance, and  even  so  only  in  a  limited  degree,  since 
the  proof  is  conclusive  that  the  author  was  antici- 
pated in  three  of  these  particulars  by  McDowell, 
19 


2g0  MCDOWELL'S  OPERATLOAT 

who  employed  silk  ligatures  on  the  pedicle  in 
mass  and  likewise  on  the  arteries  individually, 
either  by  bringing  the  ends  out  in  the  wound 
or  by  cutting  them  off  close  to  the  knots  in  both 
cases,  and  returning  the  pedicle  as  circumstances 
demanded.  To  be  sure  the  author  used  in  his 
selected  case  a  string  of  leather  on  the  pedicle, 
as  a  mode  of  constriction  by  animal  substance, 
with  a  view  of  securing  more  speedy  and  cer- 
tain absorption,  as  a  supposed  advantage  over 
a  silk  ligature.  But,  while  the  result  was  suc- 
cessful and  satisfactory  in  this,  his  first  employ- 
ment of  the  principle,  the  practice  soon  proved 
to  be  dangerous,  without  having  any  real  ad- 
vantage over  silk,  and  consequently  was  aban- 
doned, or  used  but  a  few  times. 

Dr.  Alban  Goldsmith  (Dr.  Alban  G.  Smith), 
as  we  have  seen,  employed  an  animal  ligature 
in  one  of  his  three  cases,  which  terminated 
fatally  from  hemorrhage.  This  result  he  attrib- 
uted to  the  slipping  off  or  the  giving  way  of  the 
animal  ligature  employed.  Dr.  Bellinger  used 
the  same  kind  of  ligature  once  with  success. 

The  author  in  the  report  of  his  case  (January, 
1822,)  does  not  make  the  slightest  mention 
of  or  allusion  to  the  publications  of  McDowell's 
two   papers   in   the    Philadelphia    Eclectic   Re- 


IAr  THE  UNITED  STATES.  29 1 

pertory,  respectively  five  and  three  years  pre- 
viously, containing  the  accounts  of  the  five 
cases  operated  upon  by  him  between  1809  and 
18 19,  which  have  been  previously  copied  here 
in  full.  Reference  to  McDowell's  Case  III.  will 
show  the  precedent  of  a  medium  incision  in  the 
same  situation,  perhaps  double  the  length  of 
that  of  the  author,  easily  admitting  one  hand 
into  the  abdomen ;  and  to  his  Case  V.,  of 
another  precedent  of  a  short  incision  in  the 
same  locality,  admitting  one  finger,  made  and 
employed  as  an  exploratory  step  to  complete 
his  diagnosis.  This  case,  it  will  be  remembered, 
was  one  of  dermoid  cyst,  complicated  with  ex- 
tensive and  strong  adhesions.  Reference  to 
McDowell's  Case  IV.  will  also  show  the  prece- 
dent of  dealing  with  the  arteries  individually  in 
a  very  short  and  spongy  pedicle,  by  "  tying  up 
the  bleeding  mouths  separately."  Not  only 
this  expedient,  which  failed  of  its  purpose  from 
the  soft  and  yielding  nature  of  the  tissues,  but 
that  of  still  another  of  far  greater  difficulty  of  exe- 
cution, will  also  be  found  explained — viz.,  "the 
arming  a  needle  with  a  strong  ligature,"  pass- 
ing the  ligature  "  round  the  ligament  (pedicle), 
securing  it  in  its  place  by  taking  several  stitches 
over   its    surface,"    and    then    tying   it   firmly. 


292  MCDOWELL'S  OPERATLON 

Though  it  is  not  stated,  the  natural  inference  is 
that  the  ends  of  the  ligature  and  the  sutures 
used  to  secure  it  in  place  were  cut  off  close  to 
the  knots,  as  any  prudent  surgeon  would  hardly 
have  taken  the  risk  (or  thought,  under  the  cir- 
cumstances) of  bringing  out  and  leaving  long 
ends  of  sutures  applied  in  this  way  in  the  lower 
angle  of  the  wound.  McDowell's  Case  V.  fur- 
nishes further  and  even  stronger  proof  of  the 
establishment  of  the  same  precedent.  Here 
were  tied  "fine  cords  of  silk  firmly  round  each 
of  these  ligaments"  ;  and  at  the  autopsy  of  the 
case,  three  days  after  death,  it  is  stated  that  it 
was  found  that  "  the  silken  cords  were  securely 
and  properly  fixed,  and  not  in  a  situation  likely 
to  injure  the  adjoining  parts."  Such  a  use  of 
fine  silk  ligatures,  and  such  remarks  upon  their 
condition  and  adaptation,  as  inspected  three 
days  after  their  employment,  admit  of  no  other 
conclusion  than  that  the  ends  had  been  cut  off 
close  to  the  knots,  and  the  loops  on  the  pedicle 
left  to  take  care  of  themselves  in  the  peritoneal 
cavity. 

The  question  of  injustice  on  the  part  of  the 
author  as  to  the  previously  published  facts  con- 
tained in  McDowell's  two  papers  is  still  an  open 
one,  and  one  of  sufficient  importance,  there  can 


IN  THE   UNITED  STATES. 


293 

be  no  doubt,  to  deserve  a  satisfactory  explana- 
tion. Philadelphia,  at  the  time  McDowell  sent 
there  the  reports  of  his  five  operations  for  the 
removal  of  diseased  ovaries,  to  be  published  in 
the  Eclectic  Repertory,  was  the  greatest  centre 
of  medical  teaching  in  this  country.  The  medi- 
cal journal  referred  to  was  as  respectable  and 
widely  known  as  any  other  then  published  in 
the  United  States.  Not  only  had  the  reports 
of  these  unique  cases  in  all  their  details  been 
brought  to  the  notice  of  the  large  number  of 
readers  of  this  periodical,  both  at  home  and 
abroad,  at  the  date  in  question  ;  but  there  had 
also  appeared  from  time  to  time,  in  the  subse- 
quent issues  of  this  journal,  sharp  criticisms 
upon  the  teachings  of  McDowell,  as  well  as 
articles  in  defence  of  them,  not  only  by  himself, 
but  by  others.  All  this,  therefore,  tended  to 
prove  beyond  question  that  there  was  an  ex- 
tended knowledge  among  intelligent  and  well- 
informed  physicians  at  that  period  of  the  great 
triumphs  of  the  Kentucky  surgeon.  Beside 
this,  Professor  James,  then  one  of  the  ablest 
teachers  of  obstetrics  and  diseases  of  women  in 
this  country  (to  whom  Dr.  McDowell  directly 
addressed  his  second  paper,  September,  181 9, 
accompanying  it  with  a  dignified  and  convincing 


294  MCDOWELL'S  OPERATION 

defence  of  the  principles  of  his  operation), 
availed  himself  of  every  opportunity  to  make 
known  to  his  large  classes  the  character  of 
these  brilliant  operations  and  the  influence 
they  would  have  upon  the  profession. 

While  all  this  was  transpiring  (including  pub- 
lications, criticisms,  and  discussions)  in  the 
medical  circles  of  Philadelphia,  regarding  this 
new  operation  of  McDowell,  and  even  the  trans- 
plantation of  the  same  to  the  little  town  of  Isny, 
in  Swabia  or  Wurtemberg,  under  the  fostering 
care  of  Dr.  Chrysmar,  what  do  we  find  going 
on  in  the  neighboring  city  of  New  Haven, 
Conn.,  another  centre,  if  not  of  medical  teach- 
ing, certainly  of  educational  and  classical  in- 
struction ? 

Our  author,  an  able  and  well-known  teacher 
of  surgery  in  Yale  Medical  College,  was  also 
directing  his  attention  to  the  same  subject.  He 
had  completed  the  cure  of  a  case  presenting  a 
small  cyst  by  the  employment  of  the  Hunterian 
short  incision,  or  by  merely  the  extension  of 
McDowell's  exploratory  incision,  puncturing 
the  tumor  and  drawing  out  its  collapsed  walls, 
weighing  only  "  two  to  four  ounces."  It  would 
seem  that  he  had  not  then  heard  of  the  achieve- 
ment of  McDowell  in  having  already  extirpated 


IN  THE  UNITED  STATES.  295 

three  diseased  ovaries  by  his  long  incision,  as  is 
inferred  by  the  failure  to  mention  his  name  or 
refer  to  his  five  published  cases.  He,  however, 
refers  in  a  foot-note  to  the  proposal  of  Pro- 
fessor Dzondi,  in  Germany,  which  had  no  bear- 
ing whatever  upon  the  operation  of  extirpation 
of  diseased  ovaries.  The  same  reference,  it  is 
proper  to  mention,  is  made  nine  years  later 
(1831)  in  his  Memoirs,  by  the  editor,  his  son. 
Even  the  son  in  this  work  states  :  "I  am  not 
confident  that  the  first  operation  of  McDowell 
(1809)  was  subsequent  to  that  of  my  father 
(1821)."  In  addition,  he  says  that  his  father 
had  since  operated  in  two  other  cases,  but  that 
he  was  compelled  to  desist  in  both  instances  on 
account  of  the  too  extensive  adhesions,  which 
were  especially  marked  in  the  second  case. 
Who  can  gainsay,  regarding  the  unfinished 
operations  in  these  two  cases,  that  the  employ- 
ment of  McDowell's  long  incision,  extending 
the  entire  length  of  the  linea  alba  (instead  of 
this  Hunterian  short  incision,  probably  the  only 
one  tried),  might  not  have  afforded  the  requisite 
facilities  for  obtaining  a  more  complete  diag- 
nosis, or  at  least  for  getting  at  and  trying  to 
overcome  the  adhesions  present,  especially  in 
the  case  of  the  large  ovarian  cyst,  and  thus  have 


296 


MCDOWELL'S  OPERATLON 


effected  a  completion  of  the  operation,  and  pos- 
sibly a  permanent  cure  ? 

Case  X. — Entitled:  "Account  of  a  Case  in  which  an 
Ovarium  was  Successfully  Extirpated  ' '  (addressed  in  the 
form  of  a  letter  to  a  gentleman  in  Philadelphia),  by  Alban 
G.  Smith,  M.D.,  of  Danville,  Kentucky.1  Patient,  a 
negress  in  the  neighborhood  of  Danville,  applied  to  Dr. 
Smith  for  treatment,  with  "a  diseased  and  dropsical  ovary." 
Operation  May  24,  1823.  "I  commenced,"  hesays,  "by 
making  an  incision  from  the  umbilicus  to  within  an  inch 
of  the  pubes  "  (medium  incision),  which  readily  admitted 
the  hand  into  the  abdomen,  and  allowed  the  lifting  out  of 
the  tumor.  Turned  patient  "over  on  the  abdomen  (at 
the  same  time  keeping  in  the  intestines  with  a  warm  cloth), 
to  allow  all  the  blood  to  escape  from  the  peritoneal  cavity." 
Used  "  a  strong  ligature  of  white  silk."  Ends  left  long 
enough  to  be  brought  out  at  the  lower  angle  of  the  wound. 
With  "five  threaded  needles"  he  "closed  the  external 
incision  by  the  interrupted  suture."  On  the  twenty-fifth 
day  ligature  came  away  and  patient  was  discharged  cured. 
He  found  the  tumor  to  be  of  "  a  scirrhous  appearance,  and 
to  contain,  interspersed  throughout  its  substance,  a  con- 
siderable quantity  of  bony  matter."  It  was,  no  doubt,  a 
dermoid  cyst. 

In  connection  with  the  publication  of  Dr. 
Smith's  case,  Dr.  Coates — one  of  the  editors  of 
the  journal  quoted — speaks  at  considerable 
length  of  Dr.  McDowell's  five  published  cases, 
and  says  : 

"  The  first  instance  of  which  we  are  aware  in  which  the 
operation  was  performed  by  a  surgeon  for  the  removal  of 

1  North  American  Med.  and  Surg.  Journ.,  1826,  vol.  i.,  p.  30. 


IN  THE  UNITED  STATES. 


297 


diseased  ovaria  is  a  memorial  of  the  courage  of  Ephraim 
McDowell,  of  Danville,  Kentucky." 

He  also  refers  to  Dr.  Nathan  Smith's  case, 
and  to  Mr.  John  Lizars's  Anatomical  Plates, 
published  in  Edinburgh,  1825. 

Also  in  connection  with  the  preceding  opera- 
tion of  Dr.  Smith  (subsequently  known  as  Dr. 
Alban  Goldsmith),  performed  in  Danville,  the 
home  of  Dr.  McDowell,  it  is  proper  here  to 
refer  to  the  statement  of  Dr.  J.  M.  Foltz,  cor- 
respondent of  the  New  York  Journal  of  Medi- 
cine? that  Dr.  Goldsmith  operated  in  two  other 
cases  of  ovarian  dropsy :  one  a  success  and 
the  other  terminating  fatally.  The  latter  result, 
on  the  authority  of  Dr.  Foltz,  was  attributed  to 
the  "giving  way  prematurely  "  of  "an  animal 
ligature  "  and  "  the  supervention  of  secondary 
hemorrhage  within  the  abdominal  cavity." 
These  two  cases  have  never  been  published  in 
detail.  Dr.  Foltz  further  credits  Dr.  Goldsmith 
with  the  statement  that  he  saw  a  patient  with 
Dr.  McDowell,  in  Danville,  who  "had  tapped 
herself  no  less  than  ninety  times,"  and  who 
presented  herself  to  Dr.  McDowell  for  the  ex- 
tirpation of  the  supposed  tumor.  "The  event, 
however,  proved,  much  to   the  surprise  of  the 

1  Vol.  i.,  Sept.,  1843. 


2q8  MCDOWELL'S  OPERATION 

two  surgeons,  that  the  tumor  was  merely  a  mass 
of  the  intestines  conglomerated  by  adhesions." 

Results. — Three  completed  operations  with 
two  cures  and  one  death;  mortality,  33^  per 
cent. 

Comments. — The  author,  although  at  one 
time  a  partner  and  an  assistant  of  Dr.  McDow- 
ell in  his  earlier  operations,  strange  to  say,  does 
not  mention  or  allude  to  him  in  the  slightest 
way  in  the  report  of  his  case.  The  distinctive 
features  of  the  operation  performed  by  him, 
however,  are  precisely  the  same  as  in  McDow- 
ell's, and  he  found  in  this  case  that  the  medium 
incision  of  the  latter,  below  the  umbilicus,  was 
sufficient  for  the  removal  of  the  tumor.  The 
ends  of  the  pedicle  ligature  were  brought  out 
at  the  lower  angle  of  the  wound,  which  was 
closed  with  interrupted  sutures,  compress,  and 
bandage  in  the  usual  way. 

The  author,  according  to  Dr.  Foltz,  as  we 
have  seen,  performed  two  other  operations  after 
this,  one  being  completely  successful,  and  the 
other  terminating  fatally  in  consequence  of  the 
giving  way  of  an  animal  ligature  employed  for 
securing  the  pedicle. 

Case  XI. — Entitled  :  "  Successful  Operation  for  Ovarian 
Disease."     By  R.  D.  Mussey,  M.D.,  then  of  Dartmouth, 


IN  THE   UNITED  STATES. 


299 


N.  H.,and  afterward  of  Cincinnati,  Ohio.1  Mrs.  Sly,  of 
Ryegate,  Vt.,  aged  forty,  consulted  Dr.  Mussey  in  the 
summer  of  1828.  She  presented  a  tumor  in  the  left  side  of 
the  abdomen,  which  was  first  noticed  one  year  previously. 
Dr.  Mussey's  operation  was  made  in  July,  1828.  "  An  inci- 
sion was  made  through  the  integuments,  at  the  linea  alba, 
from  the  umbilicus  to  the  symphysis  of  the  pubis. ' '  He  found 
the  tumor  covered  ' '  by  the  mesocolon,  the  transverse  colon 
being  situated  below  the  tumor,  extending  from  iliac  to  iliac 
regions.  All  that  could  be  safely  attempted  was  to  dis- 
charge the  fluid,  and  take  measures  to  inflame  the  interior 
surface  of  the  cyst."  Through  "one  of  the  meshes  of  the 
beautifully  injected  mesocolic  vessels  a  puncture  was  made 
large  enough  to  admit  a  catheter,  by  which  the  fluid, 
slightly  turbid,  and  amounting  to  between  four  and  five 
pints,  was  drained  off.  The  opening  was  then  enlarged, 
and  a  tent  of  twisted  charpie  introduced  a  little  way  into 
the  sac,  the  other  extremity  being  left  to  hang  out  exter- 
nally." Usual  treatment  of  the  wound  by  sutures,  com- 
press, and  broad  band  around  the  abdomen.  At  the  end  of 
"  three  weeks  the  discharge  was  trifling,  and  the  opening 
speedily  closed."  Patient,  about  a  year  afterward,  gave 
birth  to  "  her  fourteenth  and  last  child." 

Dr.  Mussey  published  this  case  about  nine 
years  after  the  operation  described,  and  he  says 
he  saw  the  patient  about  two  years  prior  to  this 
date  (1837),  at  which  time  she  was  well,  thus 
proving  the  probability  that  the  tumor  was  a 
fibrocystic  growth,  and  not  an  ovarian  cyst. 
His  convictions  at  the  time  of  reporting  the  case 
were  that  when  a  tumor  "is  wholly  or  in  part 
fleshy,"    and   presenting   grave    complications, 

^mer.  Journ.  Med.  Sciences,  1837,  vol.  xxi.,  p.  380. 


,00  MCDOWELL'S  OPERATLON 

such  for  example  as  here  existed,  no  sort  of 
operation  for  removal  is  practicable  "  without 
subjecting  the  life  of  the  patient  to  imminent 
hazard."  He  further  says:  "I  could  cite  four 
cases  of  this  kind,  and,  if  proper,  could  desig- 
nate the  several  operators,  who  thus  gave  them- 
selves occasion  to  repent  of  their  temerity." 

Comments. — In  connection  with  the  author's 
case,  it  is  proper  to  state  that  although  he  was 
present  at  the  first  operation  of  Professor  Na- 
than Smith,  in  the  case  of  Mrs.  Strowbridge, 
in  1 82 1,  and  therefore  had  had  some  practical 
knowledge  from  direct  observation,  he  did  not 
employ  the  short  incision  used  by  him.  Among 
the  four  cases  of  unfinished  operations  in  the 
hands  of  other  surgeons,  to  which  he  refers,  he 
probably  had  in  mind  the  two  unfinished  opera- 
tions of  his  colleague,  Professor  Smith,  which 
were  brought  to  the  notice  of  the  profession  by 
his  son,  Dr.  Nathan  R.  Smith,  in  1 831,  as  has 
been  mentioned.  I  will  add  that  Dr.  Mussey 
makes  not  the  slightest  reference  to  Dr.  Mc- 
Dowell or  his  operations. 

Case  XII. — Entitled  :  "  Case  of  Ovarian  Tumor  Suc- 
cessfully Extirpated."  By  David  L.  Rogers,  M.D.,  New 
York.1  The  patient,  Mary  Gurly,  consulted  Dr.  Rogers  in 
regard  to  a  large  tumor  in  the  left  side  of  the  abdomen  about 

1  Med.  and  Physical  Journal,  Jan.  1830,  vol.  ii.,  p.  284. 


IN  THE  UNITED  STATES. 


30I 


two  months  before  his  operation.  She  had  been  tapped  five 
times,  and  the  quantity  of  fluid  drawn  off  was  computed  at 
about  eighteen  gallons.  Operation  September  14,  1829. 
Present,  Drs.  Mott,  Vache,  and  J.  H.  Rogers.  He 
says:  "  I  commenced  an  iacision  a  little  below  the  ensi- 
form  cartilage,  carrying  it  parallel  with  the  linea  alba,  and 
terminating  at  the  symphysis  pubis."  The  adhesions  were 
somewhat  extensive  :  "some  separated  by  the  finger,  others 
by  the  handle  of  the  scalpel.  After  occupying  two  hours 
in  the  operation,  the  huge  mass  of  disease  was  safely  re- 
moved and  laid  on  the  table."  The  ligatures  on  the 
bleeding  vessels  and  pedicle  were  all  cut  off  close  to  the 
'knots  and  left  to  absorption.  "The  wound  was  closed  by 
sutures,  dressed  with  adhesive  strips,  lint,  a  compress,  and 
a  bandage  applied  firmly  to  the  abdomen."  One-third  of 
the  tumor  was  solid,  containing  a  fibro-cartilaginous  sub- 
stance. 

In  connection  with  the  history  of  the  operation 
Dr.  Rogers  says  : 

"Dr.  McDowell,  of  Kentucky,  has  reported  three  cases 
in  which  he  operated  successfully  for  tumors  in  the  abdo- 
men, ovarian  and  hydatid.  A  doubt  exists  in  relation  to 
these  cases,  and  certainly  the  mode  of  describing  them  is 
calculated  to  confirm  that  doubt.  We  are  bound,  how- 
ever, upon  the  authority  of  others,  to  believe  them,  not- 
withstanding the  improbabilities  connected  with  their 
details ;  and  it  is  much  to  be  regretted  that  a  more  cir- 
cumstantial account  of  these  cases  has  not  been  given  to 
the  profession." 

Dr.  Rogers  then  refers  to  Dr.  Nathan  Smith's 
case  and  its  result ;  concluding  his  report  with 
the  following  statement  of  statistics  :  "  Thus  we 
find   in   the  twelve  operations  that   have  been 


302  MCDOWELL'S  OPERATION 

performed  for  the  removal  of  this  disease, 
seven  have  been  successful,  and  two  remained 
doubtful." 

Comments. — The  author  in  the  description  of 
his  operation  clearly  shows  that  he  had  studied 
well  the  operations  of  McDowell  and  followed 
his  method  to  the  letter ;  using  silk  ligatures 
for  the  pedicle  and  bleeding  vessels,  cut  off  close 
to  the  knots,  as  McDowell  did  in  Cases  IV.  and 
V.  It  appears  a  little  strange  that  the  author 
should  have  limited  his  reference  and  criticisms 
to  McDowell's  first  three  cases,  treated  by- 
bringing  out  the  ligatures  in  the  lower  angle  of 
the  wound,  not  making  the  slightest  mention  of 
his  second  paper,  containing  the  report  of  his 
fourth  and  fifth  cases.  It  must,  however,  be 
added  to  the  author's  credit  that  he  was  the 
first  of  the  four  surgeons  in  this  country,  who 
had  up  to  this  time  undertaken  the  operation 
for  extirpation  of  the  ovary,  to  make  any  refer- 
ence whatever  to  the  teachings  of  McDowell. 
Another  interesting  fact  deserving  of  mention 
is,  that  this  case  was  the  last  one  operated  upon 
and  published  in  the  United  States  prior  to  the 
death  of  the  "Father"  of  the  operation,  which 
occurred  at  his  home,  Danville,  Kentucky,  June 
20,   1830.      "A  prophet   is   not  without   honor 


IN  THE  UNITED  STATES. 


303 


save  in  his  own  country,"  does  not  apply  in  this 

instance,  at  least. 

Case  XIII.— Entitled :  "Tumor  of  the  Ovarium,"  by 
J.  C.  Warren,  M.D.,  of  Boston.1  Dr.  Warren,  in  the  pre- 
sentation of  this  subject,  calls  attention  to  "  two  kinds  of 
ovarian  enlargement,"  viz.:  ''scirrhous  and  dropsical." 
In  illustration  of  the  former  variety  he  cites  a  case,  that  of 
Catharine  Wait,  single,  aged  forty,  admitted  to  the  Massa- 
chusetts General  Hospital,  October  28,  1830.  The  patient 
had  noticed  a  tumor  in  her  right  side  four  years  previously, 
and  her  catamenia  had  been  profuse.  Dr.  Warren  per- 
formed the  operation  for  removal  of  this  tumor  November, 
1830.  "An  incision  was  carried  from  above  downward 
through  the  linea  alba,  the  length  of  twelve  inches."  A 
"broad  adhesion  "  was  found  in  "the  lower  part  "  of  the 
abdomen,  and  it  "was  encircled  by  a.  thick  ligature." 
Under  this  "  ligature  a  needle  with  a  double  thread  was 
carried  through  the  adhesion  and  tied  on  each  side.  The 
adhesion  was  then  cut,  and  the  tumor  removed.  Owing  to 
the  shortness  of  the  pedicle  the  ligature  partially  slipped 
off  as  soon  as  the  scirrhus  was  taken  away,  and  though  the 
vessels  were  secured  as  fast  as  possible,  they  were  so  num- 
erous and  large  that  the  patient  in  a  short  time  sunk  from 
loss  of  blood."  The  tumor  weighed  "  about  twenty-five 
pounds,"  and  was  "of  almost  cartilaginous  hardness." 
Dr.  Warren  concludes  his  remarks  on  this  case  and  the 
result  of  the  operation  in  these  words :  "  The  event  of  this 
case  has  led  me  to  decline  repeating  the  operation ;  and  I 
should  advise  others  to  decline  it  unless  there  were  some 
peculiar  insulation  of  the  tumor,  as  when  it  formed  a  hernia 
or  when  it  had  a  very  long  and  narrow  pedicle." 

Of  the  dropsical  variety  of  ovarian  tumors 
Dr.  Warren  goes  on  to  state  that  he  had  met 

1  Surgical  Observations  on  Tumors,  with  Cases  and  Operation, 
1839. 


304  MCDOWELL'S  OPERATION 

with  one  case,  that  of  a  lady  who  had  undergone 
three  tappings.  Soon  after  the  third  she  died, 
and  the  autopsy  revealed  a  cyst  with  walls  a 
quarter  of  an  inch  thick  and  filled  with  hydatids. 
Comments. — The  author  in  his  operation  cer- 
tainly encountered  grave  difficulties,  and  per- 
haps met  them  as  courageously  as  any  one  else 
at  that  time  could  have  done ;  but  the  trouble 
at  the  outset  was  unquestionably  an  error  in 
diagnosis  as  to  the  true  character  of  the  tumor, 
and  not  due  to  any  fault  of  the  operation  by 
McDowell's  long  incision,  which  was  employed, 
though  no  mention  is  made  of  the  latter  sur- 
geon. The  facts  of  the  case  prove  that  the 
tumor  was  a  pedunculated  fibroma  of  the  uterus, 
somewhat  similar  to  Case  IV.  of  McDowell's 
record,  which  presented  a  like  difficulty  in  the 
management  of  the  pedicle,  though  with  a  far 
different  final  result.  In  the  dropsical  variety 
of  ovarian  tumors,  as  described  in  this  same 
connection,  the  author  would  probably  have 
been  more  successful  in  the  employment  of  the 
operation,  and  would  have  had  less  cause  for 
condemning  it.  This  want  of  experience  as  to 
the  diagnosis  of  the  different  varieties  of  tumors, 
both  previously  to  this  and  for  some  time  after- 
ward,  proved  more  prejudicial  than  anything 


IN  THE  UNITED  STATES. 


305 


else    to    the    acceptance    of    the    teachings    of 

McDowell. 

Case  XIV. — Entitled:  "Extirpation  of  an  Ovarian 
Tumor,  Complicated  with  Hydrops  Uteri — Recovery." 
By  John  Bellinger,  M.D.,  Charleston,  S.  C.1  Patient, 
a  negress,  aged  thirty-five,  first  noticed  in  1834  a  round 
tumor  in  the  right  side  of  the  abdomen.  Applied  to  Dr. 
Bellinger  for  treatment  about  a  year  later.  He  performed 
the  operation  for  the  removal  of  this  tumor  December  23, 
1835,  in  the  presence  of  Drs.  Dixon,  Prioleau,  and  Ogier. 
"  The  subject  being  corpulent  the  incision  was  commenced 
above  the  umbilicus,  and  extended  to  the  symphysis  pubis"; 
afterward  "continued  nearly  to  the  ensiform  cartilage." 
No  adhesions  mentioned.  Pedicle  divided.  "Two  arteries 
of  considerable  size  required  tying ;  animal  ligatures  were 
applied  and  both  ends  cut  away  near  the  knots."  Patient 
recovered.  Tumor  fibrous,  with  "the  dimensions  of  a 
medium-sized  fist." 

Comments. — The  author  in  his  title  indicates 
the  removal  of  an  ovarian  tumor,  but  after  its 
removal  describes  it  as  a  fibrous  growth — a 
discrepancy  that  may  appear  singular,  though 
it  was  not  an  unusual  thing  for  writers  to  do 
even  many  years  after  the  date  of  this  opera- 
tion ;  a  habit  resulting,  no  doubt,  from  the 
belief  that  the  operation,  as  proposed  by  Mc- 
Dowell, was  intended  solely  for  the  removal  of 
the  former  variety  of  tumors,  and  not  for  the 
latter.     The  author  makes  no  mention  of  Mc- 

1  Southern  Journal  of  Medicine  and  Pharmacy,  May,  1847, 
p.  241. 
20 


306  MCDOWELL'S  OPERATION 

Dowell  in  the  report  of  his  case,  though  he  em- 
ployed his  long  incision,  with  a  full  understand- 
ing of  its  advantages  for  securing  access,  light, 
and  freedom  of  manipulation,  even  for  the  re- 
moval of  a  tumor  so  small  as  the  one  found  to 
exist. 

After  this  the  operation  fell  into  total  neglect 
in  the  United  States  for  eight  years,  only  the 
above  and  the  preceding  operation  being  per- 
formed during  the  thirteen  years  intervening 
between  the  death  of  Dr.  McDowell  and  the 
time  of  the  revival  of  the  operation  here  by  the 
late  Dr.  John  L.  Atlee,  of  Lancaster,  Pa.,  June 
29,  1843,1  nearly  one  year  after  the  latter 
occurred  in  England  (1842). 

Summary  of  cases  and  results  in  the  United 
States,  including  the  two  cases  of  Dr.  Nathan 
Smith  referred  to  by  his  son,  Dr.  Nathan  R. 
Smith,  and  the  two  cases  of  Dr.  Alban  G.  Smith 
referred  to  by  Dr.  Foltz,  but  not  here  brought 
out  in  detail,  making  in  all  18  cases — 12  com- 
pleted operations  with  9  cures  and  3  deaths ;  6 
unfinished  operations  with  6  recoveries.  Mor- 
tality of  completed  operations,  25  per  cent. 

1  Am.  Journ.  of  Med.  Sciences,  Jan.  1844,  vol.  xxxiii.,  p.  44. 


IN  FRANCE.  307 

SECTION    II. 

France. 

The  history  in  France  of  tapping  and  inci- 
sionism,  with  injections  and  drainage,  as  means 
of  relieving  and  curing  encysted  dropsy  of  the 
ovary,  may  be  said  to  be  extensive  as  compared 
with  that  of  other  countries ;  and  the  modern 
writers  entitled  to  most  consideration  upon  the 
subject  are  Lisfranc,  Velpeau,  Vidal,  De  Cassis, 
and  Malgaigne.  It  is  not  my  purpose  here  to 
attempt  a  review  of  all  the  interesting  points 
connected  with  these  several  subjects  brought 
out  by  these  authors,  but  simply  to  indicate,  by 
a  few  brief  extracts,  how  the  first  proposal  of 
extirpation  of  a  dropsical  ovary,  as  an  advance 
upon  former  teachings,  came  to  be  made,  and 
how  the  principle  was  regarded  afterward.  Lis- 
franc, in  connection  with  his  discussion  of  inci- 
sionism,  speaks  of  the  importance  of  effecting 
artificial  adhesion  between  the  dropsical  ovary 
and  the  abdominal  wall  by  the  employment  of 
caustic  potash  over  the  point  of  election  for  the 
operation,  as  a  preparatory  measure,  when  a 
close  relationship  of  the  parts  had  not  already 
taken  place  from  the  existing  disease,  a  condi- 


308  MCDOWELL'S  OPERATION 

tion  of  things  desirable  for  the  operation,  being 
similar  to  that  met  with  in  abscess  of  the  ovary. 
He  says,  however,  that  he  had  seen,  and  even 
himself  tried,  the  expedient  referred  to,  but  it 
was  uncertain  ;  and  at  best  it  usually  failed  of 
its  purpose,  viz. :  to  prevent  the  fluids  contained 
in  the  cyst  from  escaping  into  the  peritoneal 
cavity,  and  causing  injurious  consequences.  In 
speaking  of  extirpation  of  the  ovary  itself,  when 
in  a  dropsical  condition,  accompanied  by  scir- 
rhous degeneration,  he  said  the  proposal  was 
based  upon  the  safety  of  the  practice  that  had 
long  before  existed  among  certain  peoples  in  the 
East  of  removing  the  normal  ovaries,  upon 
which  he  comments  as  follows : 

"Plater,  Delaporte,  Morand,  Diemebroeck,  Darwin, 
veulent  qu'on  pratique  T  extirpation  del' affection  morbide, 
lorsque  l'hydropisie  de  l'ovaire  est  accompagnee  d'une 
degenerescence  squirrheuse,  ou  bien  quand  la  tumeur  est 
composee  de  plusieurs  loges  qui  ne  communiquent  pas 
entre  elles  et  qui  ne  permettent  pas  de  la  vider ;  ils  pensent 
que  cette  operation  peut  etre  faite,  puisqu'  on  y  a  reeours 
presque  sans  danger  sur  les  femelles  de  plusieurs  animaux 
qu'  on  veut  rendre  steriles ;  Athenee  et  Suidas  rapportent 
qu'Adrometes  et  Gyges  faisaient  pratiquer  l'ablation  des 
ovaires  a  beaucoup  de  femmes,  pour  qu'elles  n'eussent  pas 
d'enfants;  on  dit  que  cette  inhumaine  et  criminelle  cou- 
tume  a  existe  chez  quelques  peuples  de  1' Orient ;  on  parle 
d'un  chatreur  qui,  ayant  concu  des  soupcons  sur  la  vertu 
de  sa  fille,  lui  enleva  les  deux  ovaires,  apres  avoir  incise  la 
paroi  de  1' abdomen ;  on  assure  que  cette  jeune  fille  guerit." 


IN  FRANCE.  309 

Notwithstanding  the  facts  presented  he 
further  adds  : 

"The  extirpation  of  ovarian  cysts  is  rejected  by  Dehaen, 
Morgagni,  Sebatier,  Gardien,  and  others.  Lemaunier, 
Smith,  Lizars,  Macdowel,  Chrysmar,  Delaporte,  Lieutaud, 
and  others,  have  extirpated  the  disease  in  question  with 
success.  It  is  likewise  known  that  some  of  the  women 
operated  upon  by  Lizars,  Martini,  and  Chrysmar,  died,  and 
most  of  them  only  a  few  hours  after  the  operation ;  and 
how  many  cases,  it  may  be  asked,  died,  and  have  been 
passed  over  in  silence  ?  We  are  not  ignorant  of  the  cases 
of  Lizars,  Granville,  Dieffenbach,  and  others,  whose  opera- 
tions were  abandoned  after  they  opened  the  peritoneal 
cavity,  because  of  the  existence  of  too  numerous  and  strong 
adhesions,  and  too  great  a  vascularity  of  the  parts  !  "  x 

Velpeau  and  Vidal  discuss  the  old  method  of 
incisionism  for  treating-  dropsical  ovaries  very 
much  in  the  same  manner  as  Lisfranc,  and  their 
views,  consequently,  do  not  call  for  special  con- 
sideration. Of  Velpeau,  however,  it  may  be 
said  that  he  is,  on  all  matters  relating  to  scien- 
tific progress,  of  the  highest  authority,  and  is, 
generally,  accurate  and  comprehensive  in  his 
reference  to  authors.  For  this  reason  a  short 
quotation  is  made  from  him,  the  passage  pur- 
porting to  be  a  reflex  of  the  history  of  the  pro- 
posals of  extirpation  of  the  disease  in  question 
in  all  countries  for  over  a  century  (172 2-1 840)  : 

1  Clinique  Chirurgicale  de  l'Hopital  de  la  Pitie,  1841.  Tome 
iii.,  p.  710, 


3io 


MCDOWELL'S   OPERATION 


1 '  Extirpation  was  already  discussed  by  Schlenker  (1722), 
Wiliius  (17311),  Peyer  (17512),  Targioni  (1752),  and  prac- 
tised by  Frankenau  and  Percival-Pott.  Extirpation  of 
the  ovary  had  also,  as  previously  stated,  occupied  the  atten- 
tion of  Delaporte,  who,  becoming  discouraged  from  his 
experience  in  the  employment  of  the  old  method  by  inci- 
sion, asked  himself  if  it  would  not  be  better  to  extirpate 
the  diseased  organ.  This  idea  was  seized  upon  and  ex- 
tolled by  Morand,  who,  after  reflection,  thought  the  opera- 
tion should  be  performed,  but  early.  Near  the  same  epoch 
Theden  proposed  the  method  that  bears  his  name,  which 
was  strongly  defended  by  Power  and  Darwin,  two  English 
surgeons.  Nevertheless,  their  efforts,  joined  to  those  made 
later  by  M.  d'Ischier,  were  not  sufficient  to  make  this  opera- 
tion acceptable.  Notwithstanding  the  success  obtained  by 
Laumonier,  notwithstanding  the  cure  of  Mme.  de  Choiseul, 
and  notwithstanding  the  happy  issue  of  the  operation 
reported  by  Kapeler,  Morand's  idea  of  extirpation  of  the 
ovary  remained  without  practical  application  until  1825, 
when  Mr.  Lizars  called  anew  the  attention  of  the  profession 
to  the  subject.  Also,  with  more  confidence  did  Drs. 
McDowell  and  Nathan,  and  Alan  Smith,  put  it  to  the 
test  in  America.  In  Germany,  Diffenbach  and  Chrysmar 
sought  to  make  it  prevail,  and  in  England  the  surgeons  of 
that  country  regarded  it  very  favorably3." 

As  there  has  always  been,  and  still  is,  a  mis- 
understanding, out  of  France,  as  to  the  facts 

1  Wiliius  recognized  the  marked  liability  of  the  ovary,  when 
it  acquired  a  large  size,  to  contract  adhesions  with  the  peri- 
toneum, and  the  serious  difficulty  and  risk  that  would  attend 
their  division  in  the  living  subject,  except  by  "an  opening  ex- 
tending the  whole  length  of  the  abdomen  ;"  though  he  thought 
so  dangerous  a  practice  would  expose  to  criticism  the  healing 
art,  "truly  divine,"  and  the  great  object  of  science,  "the  con- 
servation of  the  human  species."     (N.B.) 

2  Peyer  fully  endorsed  the  views  of  Wiliius.     (N.B. ) 
*  Dictionnaire  de  Medecine,  1840,  t.  xxii.,  p.  590. 


IN  FRANCE.  3 1 1 

relating-  to  the  first  proposal  of  extirpation  of  a 
diseased  ovary  in  that  country,  and  as  to  the 
claims  of  priority  in  the  operation,  incorrectly 
ascribed  to  surgeons  there,  I  have  deemed  it 
proper  to  premise  my  presentation  of  the  sub- 
ject by  the  foregoing  quotations  from  authors  of 
acknowledged  authority.  This  I  have  done  in 
order  that  I  mio-ht  be  able  to  examine  the  facts 

o 

which  are  to  follow  more  carefully  and  connect- 
edly, and  thereby  to  remove,  if  possible,  the  mis- 
understanding referred  to  among  writers.  This 
misunderstanding  and  the  discrepancies  arising 
therefrom,  and  existing  for  so  many  years  in  all 
countries,  even  in  France,  as  shown  from  what 
has  already  been  brought  out,  have  proved  most 
prejudicial  to  McDowell's  claims  of  originality, 
the  defence  of  which  is  the  object  of  this  investi- 
gation. 

Incisionism. — My  plan  now  of  presenting-  the 
subject  is  to  bring  out,  in  the  first  place,  all  that 
relates  to  the  employment  in  France  of  the  old 
procedure  of  incisionism  for  the  relief  and  cure 
of  encysted  dropsy  of  the  ovary,  as  immediately 
preceding  the  proposal  there  of  extirpation  of 
the  diseased  organ.  This  old  procedure  is  gen- 
erally supposed  to  have  first  originated  in  that 
country,  but  the  facts  do  not  support  the  claim. 


3I2  MCDOWELL'S  OPERATION 

The  credit  of  the  first  employment  of  incisionism 
is  unquestionably  due  to  Great  Britain,  the 
earliest  case  on  record  beino-  that  of  Dr.  Robert 
Houston  (1701),  as  I  shall  show  later  on. 

The  surgeons  to  whom  I  shall  particularly 
refer  in  connection  with  the  employment  of  the 
method  of  incisionism  for  the  treatment  of  drop- 
sical ovaries,  and  the  proposed  extension  of  it 
to  the  procedure  of  extirpation  of  the  diseased 
organ  itself,  are  Le  Dran,  Delaporte,  and 
Morand.  The  reports  and  comments  upon  the 
subject  by  these  three  surgeons  (the  first  named 
in  relation  to  incisions,  with  injections  and  a 
drainage  tube,  and  the  other  two  to  incisions 
and  extirpation)  are  found  given  at  consider- 
able length  in  an  analysis  based  upon  the 
Memoires  de  l'Academie  Royale  de  Chirurgie, 
and  published  under  the  title  :  Plusieurs  Me- 
moires et  Observations  sur  U  Hydropisie  En- 
kystee  et  le  Squirrhe  des  Ovaries.  Par  M. 
Marjolin.1 

These  Memoires  comprise  seven  cases  of 
encysted  dropsy  of  the  ovary,  but  only  such 
cases  as  serve  to  illustrate  the  subject  will  be 
introduced  at  length,  two  by  Le  Dran,  and  one 
by  Delaporte.     The  other    four  cases,  though 

*  Encyclopedic  des  Sciences  Medicales,  1837,1.  39,  p.  50. 


IN  FRANCE.  2  1 3 

illustrating  some  interesting  features  of  the  dis- 
ease in  question,  are  only  incidentally  and  briefly 
referred  to,  as  showing  dates  and  the  way  in 
which  the  pathology  of  such  cases  was  generally 
regarded  by  physicians  at  that  period. 

Le  Dran  (i  736). — Report  entitled :  Encysted- 
Dropsy  Treated  by  an  Operation  from  which  a 
Fistula  Remained — begins  by  pointing  out  the 
differences  between  general  dropsyand  encysted 
dropsy.  Next,  in  illustration,  he  describes  a 
case  of  abdominal  distention  for  which  he  tapped 
the  patient  twice,  at  an  interval  of  three  or  four 
months.  He  drew  off  the  first  time  "  thirty-six 
pounds  of  fluid,  which  was  of  a  muddy  color, 
and  had  a  bad  odor,"  and  which,  after  standing 
for  a  day,  deposited  "from  fifteen  to  sixteen 
ounces  of  blood,  in  the  shape  of  small  clots." 
The  second  time  he  drew  off  about  the  same 
quantity  of  fluid,  and  it  was  of  a  like  quality. 
The  patient  had  almost  all  the  time  a  continued 
fever,  more  or  less  brick-dust  deposit  in  the 
urine,  and  general  pelvic  and  abdominal  pains, 
together  with  other  symptoms  not  commonly 
met  in  general  dropsy.  She  died  in  twelve  days 
after  the  second  tapping.  The  autopsy  dis- 
closed   the  existence    of  "a  laree    number  of 

<z> 

scirrhous  tumors    in  both  iliac  fossae,"  with  a 


3i4  MCDOWELL'S  OPERATION 

defined  cyst,  within  the  peritoneal  cavity,  firmly 
adherent  to  the  parietes  of  the  abdomen  in 
front  and  on  the  sides,  thus  cutting  off  from  view- 
all  the  abdominal  and  pelvic  viscera,  and  caus- 
ing the  cavity  to  appear  as  if  "all  its  contents 
had  been  removed."  Le  Dran  describes  the 
abdominal  cavity  as  being  lined  by  the  walls  of 
a  great  cyst,  varying  from  two  to  four  lines  in 
thickness,  and  constituting  a  part  of  the  "scir- 
rhous tumors"  discovered  in  the  "  iliac  fossae." 
He  found  that  this  patient  was  relieved  for  a 
time  after  each  tapping,  and  he  was,  therefore, 
led  to  conclude  "that  if  the  cyst  in  such  cases 
could  be  prevented  from  refilling"  a  cure  might 
be  effected,  or,  at  least,  life  be  prolonged  by  it. 
He  cites  a  similar  case,  reported  by  Wander- 
viel,  which  was  treated  by  Nuck.  From  his 
experience  and  study  of  the  subject  Le  Dran 
was  led  to  try  the  plan  of  treatment  indicated 
in  the  title  and  outlined  in  the  following  case: 

September,  1736,  a  woman,  aged  sixty,  presented  herself 
with  an  abdominal  tumor,  first  noticed  eighteen  months 
previously,  and  suffering  considerable  discomfort  from  its 
gradually  increasing  size.  It  was  found  fixed  in  the  hypo~ 
gastric  region,  extending  up  from  both  iliac  regions,  par- 
ticularly the  left,  rounded  like  a  distended  bladder,  and 
reaching  as  high  as  the  umbilicus.  Fluctuation  was  indis- 
tinct, owing  to  its  hardness,  especially  on  the  left  side. 
Le  Dran  expressed  the  opinion  that  the  tumor  should  be 


IN  FRANCE.  3  1 5 

opened  "in  a  good  part  of  its  extent  the  length  of  the 
linea  alba"  below  the  umbilicus,  to  prevent  its  refilling, 
but  the  physician  in  attendance  objected  to  the  procedure, 
claiming  that  it  was  better  first  to  tap  the  patient,  to  see 
whether  there  were  "any  scirrhous  masses  in  the  sac  when 
emptied."  Accordingly,  the  patient  was  allowed  to  go  on 
until  January,  1737,  when  the  tumor  had  extended  up  to 
the  diaphragm,  and  she  was  tapped  by  the  physician  in 
charge,  fifteen  pints  of  sanguinolent  fluid  being  drawn  off. 
Seven  weeks  later  (February)  she  was  tapped  a  second  time, 
in  the  right  side,  when  twelve  pints  of  fluid  escaped,  the 
canula  being  now  allowed  to  remain  in  the  cyst  to  insure 
drainage.  M.  Le  Dran  saw  the  patient  two  days  after- 
ward, when  he  found  a  little  purulent  fluid  escaping 
through  the  tube,  and  the  left  iliac  region  "filled  by  a 
scirrhous  tumor.  Its  situation  and  its  rounded  outline 
seemed  to  indicate  that  it  was  the  ovary,  which  had  become 
swollen  and  scirrhous,  as  is  often  observed."  The  tumor 
now  was  so  much  larger  than  when  he  first  saw  the  case 
(six  months  previously)  that  he  did  not  have  as  much  hope 
of  curing  it  by  his  proposed  plan  of  treatment,  to  wit,  by 
incision  and  the  setting  up  of  inflammation  and  suppura- 
tion of  the  sac.  Nevertheless,  he  proceeded  to  enlarge  the 
trocar  opening  in  the  right  side.  This  he  did  by  introduc- 
ing a  grooved  director,  and  making  upon  it  an  incision 
downward  four  inches  in  length,  thus  laying  open  the 
abdomen.  On  introducing  his  finger,  however,  he  could 
not  feel  the  cyst-wall.  At  first  the  edges  of  the  wound 
were  kept  apart  with  charpie,  afterward  by  means  of  a 
tube  made  of  sheet  lead,  through  which  direct  drainage  was 
effected,  and  injections  made  night  and  morning.  For 
four  weeks  there  was  considerable  discharge,  intermixed 
with  shreds  of  the  cyst-walls,  as  was  supposed,  through  the 
drainage-tube  ;  but  this  gradually  grew  less  and  less,  and  at 
the  end  of  about  five  months  after  the  first  opening  was 
made  (the  drainage-tube  having  been  left  off)  a  fluctuating 
tumor  was  found  in  the  hypogastric  region.     A  somewhat 


3i6 


MCDOWELL'S  OPERATLON 


transverse  incision,  six  to  seven  inches  in  length,  was  now 
made  from  the  original  point  of  puncture  in  the  right  side, 
in  the  direction  of  the  axis  of  the  tumor,  four  fingers' 
breadth  above  the  pubes.  "A  part  of  the  right  rectus 
muscle,  and  all  of  the  left,  together  with  the  oblique  and 
transverse  muscles  of  this  side,  were  cut  through."  In  the 
operation  the  left  epigastric  artery  was  divided,  and  had  to 
be  tied.  Two  pints  of  fluid,  of  a  sanious  character,  first 
escaped,  "and  then  another  pint  of  a  different  nature  came 
from  the  left  iliac  fossa."  On  passing  the  hand  into  the 
latter  region  the  tumor  present  six  months  previously 
could  not  now  be  felt.  The  wound  was  stuffed  with  lint, 
which  was  removed  as  often  as  necessary,  the  drainage  tube 
after  a  time  being  made  to  take  its  place.  The  wound  healed 
in  seven  weeks,  leaving  a  fistula.  The  patient  lived  four 
years.  At  the  autopsy  the  cyst  was  found  "  shrivelled  up," 
and  having  a  fistulous  outlet,  and  the  intestines  were  seen 
to  be  matted  together,  adhering  to  the  cyst-walls  at  several 
points.  "  Scirrhous  tumors  of  various  sizes,  and  adherent 
.one  to  another,"  were  found  in  the  intestinal  mass  and  in 
the  hypogastric  regions. 

M.  Le  Dran  drew  the  following  conclusions 
from  this  case : 

"Encysted  dropsy  of  the  abdomen  is  almost  always 
caused  by  a  scirrhous  tumor,  and  is  developed  from  it. 
The  cyst,  however  small,  is  always  full  of  fluid.  Encysted 
dropsy  can  only  be  cured  by  a  large  incision  in  the 
cyst.  The  cyst  must  be  opened  early.  It  is  not  suffi- 
cient to  make  a  simple  puncture  with  a  trocar,  but  the 
opening  must  be  of  sufficient  size  that  the  cyst  may  sup- 
purate before  the  incision  closes.  Though  this  mode  of 
cure  is  only  palliative,  it  ought  to  be  practised,  for  it  pro- 
longs life." 

M.  Le  Dran's  second  case.     Report  entitled : 


IN  FRANCE. 


317 


"Encysted  Dropsy  Cured  by  Incision  ;  No  Fis- 
tula remaining." 

In  1746,  a  woman,  aged  forty-two,  after  having  general 
derangement  of  her  health  and  abdominal  enlargement  for 
two  years,  consulted  M.  Le  Dran,  who  tapped  her  and  drew 
off  "fifteen  pints  of  a  muddy,  foul-smelling  fluid."  After 
the  cyst  was  emptied  he  was  able  "  to  make  out  a  scirrhous 
tumor,  about  the  size  of  a  melon,  in  the  left  iliac  fossa." 
He  says  that  after  three  weeks  the  sac  had  refilled,  and  was 
as  large  as  it  was  at  the  first  tapping.  Next  comes  an 
account  of  M.  Le  Dran's  operation,  and  his  explanation  of 
its  adaptation  to  the  case.  "An  incision  was  made  in  the 
linea  alba,  a  little  below  the  umbilicus,  of  sufficient  length 
not  to  close  up  promptly,  so  that  the  lower  angle  of  it 
would  always  be  near  the  bottom  of  the  sac  as  the  latter 
contracted  and  approached  the  scirrhous  tumor.  A  large 
canula  was  placed  in  the  incision  to  prevent  its  closure, 
and  to  allow  of  suitable  injections  being  made."  After  the 
operation  the  patient  had  nausea  and  vomiting,  followed  by 
fever  and  delirium,  which  lasted  three  weeks,  during  which 
time  the  stomach  would  retain  only  Spanish  wine.  During 
this  period  "  six  to  eight  ounces  of  a  reddish,  muddy  liquid 
escaped  daily  through  the  canula,"  after  which  this  liquid 
became  clearly  purulent.  "  Finally,  one  morning,  when 
twelve  to  fifteen  ounces  of  clear  white  pus  suddenly  escaped, 
it  was  thought  that  the  scirrhous  tumor  had  begun  to  sup- 
purate, and  that  its  contents  had  discharged."  The  patient 
from  this  time  on  rapidly  improved  in  strength,  and  the  dis- 
charge of  pus  gradually  diminished,  so  that  at  the  end  of 
six  months  only  a  teaspoonful  a  day  escaped.  This  slight 
drainage  went  on  for  three  years,  at  the  end  of  which  time 
the  drainage-tube  escaped,  and  the  patient  could  not  return 
it,  whereupon  the  fistula  soon  closed,  and  the  patient  con- 
tinued completely  cured. 

Here  follow  the  reports  of  four  other  cases  of 


3 1 8  MCDOWELL'S  OPERATION 

encysted  dropsy  and  scirrhous  ovaries,1  one  by 
M.  Mouton  (1731),  the  case  of  a  woman,  aged 
thirty-nine,  presenting  an  encysted  dropsy  be- 
tween the  peritoneum  and  the  abdominal  mus- 
cles. This  woman  had  consulted  a  number  of 
surgeons  regarding  her  case  during  the  pre- 
vious two  years,  and  finally  M.  Boudou,  of  Paris, 
'  but  she  would  never  consent  to  be  tapped.  She 
died  February  of  the  same  year.  The  interest- 
ing point  is  that  during  the  last  two  weeks  of 
her  life  she  was  only  able  to  rest  in  her  bed 
upon  her  knees,  and  literally  "  fell  dead."  The 
dimensions  of  her  body  were  simply  enormous, 
the  girth  being  six  feet  seven  inches,  and  the 
distance  from  the  ensiform  cartilage  to  the  pubis 
three  feet  four  inches.  At  the  autopsy  the  cyst 
was  found  in  the  abdominal  wall,  as  stated,  to 
contain  sixty  pints  of  fluid,  of  the  color  and  con- 
sistence of  the  dregs  of  wine.  No  fluid  was 
found  in  the  peritoneal  cavity,  the  organs  there 
all  being  found  healthy. 

One  case  of  encysted  dropsy  of  the  perito- 
neum, by  M.  De  La  Chaud.  This  patient  was 
tapped  three  times,  the  quantity  of  fluid  dimin- 
ishing from  twenty  to  ten  pints  at  the  third 
operation.     At  the  autopsy  the  cavity  contain- 

1  Op.  Cit. 


IN  FRANCE,  r^ig 

ing  the  fluid  was  found  to  be  between  two  folds 
of  the  peritoneum. 

One  case  of  dropsy  of  the  ovary,  by  M.  Mon- 
taulieu.  The  woman  was  aged  forty-five,  and 
had  been  tapped  nineteen  times  in  eleven 
months.  She  died  March  13,  1732.  The 
autopsy  showed  a  large  cyst  filling  the  entire 
abdomen,  with  but  few  adhesions,  and  found 
connected  with  the  left  ovary.  Here,  on  the 
inside  of  the  cyst,  were  "several  masses  of 
scirrhous  and  ulcerated  tumors"  of  a  "cauli- 
flower form,"  no  doubt  of  a  papillomatous 
origin. 

One  case  of  scirrhus  of  both  ovaries,  com- 
plicated with  general  dropsy,  by  M.  Malaval. 
The  patient,  at  the  age  of  forty,  began  to  notice 
distinct  enlargements  on  both  sides  of  her 
abdomen,  which  developed  into  two  round  and 
smooth  tumors,  easily  felt  through  the  abdo- 
minal wall,  and  which  would  fall  from  side  to 
side  as  she  turned  in  bed.  When  this  woman 
consulted  M.  Malaval  there  was  uniform  disten- 
tion of  the  abdomen,  but  not  great  enough  to 
demand  tapping,  and  the  patient,  having  taken 
the  ordinary  remedies  without  effect,  soon  after- 
ward died.  The  autopsy  showed  a  small  col- 
lection of  fluid  in  the  peritoneal  cavity,  and  the 


320  MCDOWELL'S  OPERATLON 

presence  of  the  two  tumors  (ovarian)  previously 
diagnosticated,  one  weighing  twelve  pounds  and 
the  other  fifteen  pounds.  The  parietal  adhe- 
sions were  slight  and  easily  broken  up. 

First  Proposal  of  Extirpation  of  a  Drop- 
sical Ovary. — Next  we  come  to  the  unique 
and  classic  case  of  this  series,  entitled  "En- 
cysted Dropsy  of  the  Ovary  Treated  by  Incis- 
ion," by  M.  Delaporte,  1753.1 

A  woman,  aged  fifty-seven,  having  "an  enormous  ab- 
dominal dropsy,"  consulted  Delaporte.  Fluctuation  was 
found  to  be  indistinct,  being  felt  only  as  an  undulatory 
wave,  which  was  accounted  for  by  the  cedematous  condi- 
tion of  the  abdominal  walls.  Under  these  circumstances 
Delaporte  introduced  a  trocar,  but  no  fluid  escaped.  A 
probe  introduced  through  the  canula  and  withdrawn  "was 
found  covered  with  a  thick  gelatinous  mass. ' ' 

Here  follow  the  description  of  the  operation 
by  Delaporte  and  his  comments  upon  the  result : 

"  On  the  following  morning  a  grooved  trocar  was  intro- 
duced a  few  fingers'  breadths  above  the  anterior  spine  of  the 
ilium  of  the  left  side,  and  an  incision,  five  finger-breadths 
in  length,  and  running  obliquely  upward  toward  the  rectus 
muscle,  was  made  through  the  abdominal  muscles,  the  peri- 
toneum, and  the  wall  of  the  underlying  tumor.  Through 
this  incision  suddenly  issued  a  mass  of  matter  resembling 
jelly,  about  the  size  of  a  child's  head,  and  in  the  course  of 
two  and  a  half  hours  thirty-five  pounds  escaped.  Then  a 
dressing  was  applied,  and  on  changing  this  fifteen  pounds 
more  escaped.     The  next  evening  the  incision  had  con- 

1  Op.  cit.,  t.  40,  p.  514. 


IN  FRANCE. 


321 


tracted  very  much.  The  following  morning  the  wound 
was  enlarged  upward,  and  five  or  six  pounds  of  jelly  again 
escaped.  This  was  on  the  third  day  after  the  first  opera- 
tion. During  the  night  of  the  third  and  fourth  day  the 
patient  was  attacked  with  profuse  diarrhoea.  On  the  night 
of  the  fourth  and  fifth  day  much  sanious  fluid  escaped 
through  the  incision.  During  the  night  of  the  fifth  and 
sixth  day  the  same  jelly-like  fluid  escaped,  and  in  the 
morning  the  wound  was  covered  with  an  eschar.  The 
diarrhoea  persisted,  and  fever  set  in.  The  tenth  day  after 
the  operation  about  a  pound  of  jelly  escaped  through  the 
wound.  The  patient  died  from  exhaustion  on  the  thirteenth 
day  after  the  operation,  after  having  furnished  in  all  sixty- 
seven  pounds  of  this  gelatinous  material.  On  opening  the 
abdomen  a  large  encysted  tumor  was  found  occupying 
almost  the  whole  of  the  abdominal  cavity  as  far  as  the  right 
hypochondrium.  On  following  up  this  tumor  it  was  found 
to  start  from  the  right  ovary.  The  tube  and  broad  liga- 
ment on  that  side  were  merged  with  the  tumor.  The  ovary 
on  the  left  side  was  perfectly  healthy.  If  the  operation 
had  been  done  earlier  would  it  not  have  been  possible  to 
prevent  the  growth  of  the  tumor,  and  consequently  the 
accumulation  of  such  a  quantity  of  fluid  ?  Supposing  that 
this  operation  should  not  prove  successful,  would  it  not 
be  possible  to  remove  the  focus  of  the  disease — namely,  the 
tumor  fanned  by  the  ovary  ?"     (The  writer's  italics.) 

M.  Morand  makes  comments  upon  the  fore- 
going cases  somewhat  in  this  manner:  He 
recognizes  the  two  forms  of  general  and  en- 
cysted dropsies,  and  states  that  the  latter  is 
much  more  common  than  is  generally  believed. 
He  refers  to  an  unique  case  of  it  published  in 
the  Royal  Academy  of  Sciences,  in  1718,  and 
says  that  "the   cyst,  with  very  delicate  walls, 


322  MCDOWELL'S  OPERATLON. 

was  found  floating  free  in  the  peritoneal 
cavity"  ;  but  that  there  was  a  different  variety, 
not  uncommon,  such  as  the  one  described  by 
M.  Delaporte.  He  states  that  the  tunics  or 
coats  of  the  ovary  constituted  the  walls  of  the 
cyst,  and  that  the  latter  admitted  of  prodigious 
dilatation.  The  cavities  of  these  cysts  were 
frequently  the  seat  of  "scirrhous  masses," 
lining  the  walls  more  or  less  extensively,  and 
the  growth  of  the  cyst  was  influenced  largely 
by  the  presence  of  these.  He  says  that  the 
encysted  dropsy  of  the  ovaries  may  be  distin- 
guished from  general  dropsy  by  its  occurring 
in  one  or  the  other  of  the  hypogastric  regions ; 
and  that  it  is  only  when  the  growth  has  attained 
sufficient  size  to  fill  the  abdomen  that  the  diag- 
nosis is  obscure.  He  recognizes  the  coexist- 
ence of  pregnancy  as  a  complication  of  en- 
cysted dropsy,  and  refers  to  a  case  where  the 
general  health  underwent  but  little  change  dur- 
ing three  terms  of  pregnancy,  the  patient 
suffering  very  little  from  the  complication  until 
the  third,  when  it  failed  to  reach  full  term. 
Tapping  in  this  case  was  made  at  the  end  of 
the  fourth  year,  and  twenty-five  pints  of  fluid 
drawn  off.  He  points  out  the  difference  in  the 
quality  of  the  fluid  found  in  the  two  forms  of 


IN  FRANCE.  323 

dropsy,  and  lays  great  stress  upon  the  consist- 
ency or  thickness  of  the  fluid  in  encysted 
dropsy  of  the.  ovary,  which  he  assigns  as  a  rea- 
son for  the  indistinctness  of  fluctuation  fre- 
quently met  with,  and  the  consequent  failure 
to  detect  it  in  many  instances.  As  to  the  mode 
of  treating  encysted  dropsy,  he  concludes  his 
comments  in  the  following  words  : 

"  It  is  a  question  if  the  proper  treatment  of  these  cases 
is  not  the  free  incision  of  the  cysts.  M.  Le  Dran  is  per- 
fectly right  in  .counselling  the  operation  before  the  tumor 
has  reached  any  great  size.  M.  Delaporte  operated  too 
late,  and  rather  with  a  view  to  improve  the  patient  than  to 
cure  her. 

"  The  incision  is  not  as  useful  in  cases  of  ovarian  dropsy 
complicated  by  scirrhous  tumors  within  the  sac ;  the  rea- 
sons for  this  are  obvious. 

"M.  Delaporte  ought  to  be  praised  for  first  enunciating 
the  idea  of  removing  the  ovary  at  the  same  time  the  fluid 
is  removed.  It  is  true,  it  would  not  be  an  easy  operation 
when  the  cyst  has  formed  many  adhesions,  but  it  ought  to 
be  attempted  early." 

Soon  after  the  period  (1753)  Delaporte 
suggested  extirpation  of  the  ovary,  for  the  cure 
of  encysted  dropsy  of  the  organ,  Theden  pro- 
posed a  method  of  operating  that  bears  his 
name,  and  which  we  find  described  in  the 
EncyclopMie  des  Sciences  Medicates ;*  as  follows  : 

1  3  Division  Chirurgie  Medecine  Operatoire,  par  Malle,  1841, 
t.  19,  p.  919. 


324 


MCDO  WELL'S  OPERA  TLON 


"  He  commences  by  making  an  incision  in  the  inguinal 
region,  extending  it  through  the  skin  and  muscles  down  to 
the  cyst,  which,  according  to  his  idea,  is  outside  of  the 
peritoneum.  He  then  dilates  the  wound  with  the  fingers, 
taking  care  to  control  the  bleeding  vessels.  This  being 
done,  he  separates  the  edges  of  the  wound  from  the  cyst, 
and  by  an  incision  into  the  latter  gives  vent  to  the  con- 
tained fluid.  He  finishes  this  step  by  detaching  and  draw- 
ing out  the  emptied  sac.  Next,  with  a  long  silk  thread, 
with  the  ends  to  project  beyond  the  wound,  he  surrounds 
the  sac  with  a  loop,  and  passes  it  down  to  the  ovary.  In 
case  the  ovary  resists  the  traction  upon  it,  he  ties  and 
strangles  the  parts  in  the  loop  of  the  ligature.  If  the  ovary 
is  found  to  be  hard  he  endeavors  to  extract  it  with  the 
fingers;  and  if  this  cannot  be  done,  he  immediately  puts 
on  the  ligature  to  cause  its  destruction.  According  to 
circumstances  he  tightens  the  ligature,  and  he  says  that 
what  is  best  to  be  done  to  prevent  accident  is  to  amputate 
the  ovary.  If  this  can  be  accomplished  without  danger  it 
should  be  attempted  by  all  means.  Once  the  sac  is  re- 
moved the  only  thing  remaining  is  to  close  the  wound." 

In  the  regular  order  of  our  study  of  the 
history  in  France  of  incisionism  for  the  treat- 
ment of  encysted  dropsy  of  the  ovary,  we  come 
to  the  consideration  of  another  classic  case  re- 
ported under  the  title:  "Observation  sur  un 
depot  de  la  trompe,  et  sur  l'extirpation  de 
l'ovarie,"  par  M.  L'Aumonier,  Chirurgien  en 
chef  du  grand  hopital  a  Rouen,  et  Corres- 
pondant  de  la  Societe.1 

The  patient,  Marie  Louise  Lagrange,  aged  twenty-one, 
entered  the  Hotel-Dieu,  January  5,  1782,  under  the  care 

1  Histoire  de  la  Societe  Royale  de  Medecine,  1782-83,  p.  296. 


IN  FRANCE. 


325 


of  M.  L'Aumonier,  feeble,  emaciated,  and  having  a  low 
fever  and  diarrhoea,  with  general  distention,  tenderness  and 
pain  of  the  entire  abdomen,  together  with  a  purulent 
vaginal  discharge,  following  her  confinement  six  or  seven 
weeks  previously.  M.  L'Aumonier,  upon  a  careful  exami- 
nation of  her  case,  discovered  a  hard,  round  tumor  in  the 
hypogastric  region,  resisting  and  painful  under  pressure. 
Firm  pressure  upon  this  tumor  was  attended  by  a  sudden 
purulent  discharge  from  the  vulva,  of  which  he  assured  him- 
self positively  by  two  or  three  similar  investigations.  By 
the  touch  he  was  able  to  determine  that  the  external  os 
uteri  was  in  a  normal  state. 

L'Aumonier  says  : 

"The  situation  of  the  tumor,  its  connection 
with  the  matter  in  the  uterus,  the  occurrence  of 
an  accouchement  six  or  seven  weeks  previously, 
and  the  empty  and  flaccid  state  of  the  mammae, 
all  pointed  to  a  milk  abscess  (depot  laiteux) 
situated  in  the  ovary  and  Fallopian  tube." 

"It  was  already  late,  and  the  strength  of  the  patient 
seemed  too  feeble  to  attempt  a  decisive  operation;  but, 
according  to  the  maxim  melius  ancefis  quam  nullum,  I  de- 
termined to  make  an  incision  through  the  integument, 
muscles,  and  aponeuroses.  It  was  made  in  the  direction  of 
the  inferior  plane  of  the  external  oblique  muscle,  com- 
mencing three  fingers'  breadth  below  the  imaginary  line 
between  the  umbilical  and  hypogastric  regions.  It  was 
four  inches  in  length,  and  made  as  carefully  as  possible  in 
order  to  spare  the  subjacent  parts.    (Side  not  mentioned.) 

"The  peritoneal  cavity  opened,  I  perceived  a  round 
tumor,  of  a  bluish  color,  adherent  below  to  the  part  of  the 
peritoneum  covering  the  inguinal  ring,  and  free  above, 
where  it  was  surmounted,  in  the  direction  of  the  umbilicus, 


326 


MCDOWELL'S  OPERATION 


by  another  oval-shaped  tumor,  the  size  of  an  egg,  having  a 
scirrhous  solidity.  The  bluish  part  of  the  tumor  was  elas- 
tic, but  fluctuation  was  distinct,  and  I  could  again,  by 
compressing  it,  cause  immediately  to  flow  from  the  vulva 
a  small  quantity  of  pus. 

"  Notwithstanding  the  size  and  considerable  number  of 
bloodvessels  which  ramified  upon  this  tumor,  I  did  not 
hesitate  to  plunge  the  bistoury  into  its  cavity.  In  directing 
this  incision  from  the  part  of  the  ovary  having  scirrhous 
hardness  to  the  point  where  the  Fallopian  tube  unites  with 
the  side  of  the  uterus,  the  opening  made  gave  issue  to  a 
pint  at  least  of  blackish  pus  of  an  odor  the  most  infectious 
and  penetrating  I  have  ever  smelled. 

"The  pus  being  evacuated,  I  passed  my  finger  as  far  as 
it  would  reach  into  the  interior  of  this  cavity,  and  in  carry- 
ing the  finger  to  the  superior  part  of  it  I  felt  an  excavation 
in  the  body  of  the  ovary,  the  edges  of  which  were  of  con- 
siderable hardness,  and  which  obliged  me  to  examine  more 
carefully  the  part  that  I  had  previously  regarded  as  scir- 
rhous. I  tried  to  detach  this  part  from  the  Fallopian  tube, 
being  sure  now  that  the  adherence  was  only  the  product  of 
inflammation.  Their  separation  was  effected  without  dif- 
ficulty, and  the  point  of  adherence  was  found  to  be  formed 
by  the  fixation  of  the  fimbriated  extremity  of  the  Fallopian 
tube  upon  the  body  of  the  ovary,  an  occurrence  which 
results  from  any  stimulation  whatsoever  of  the  latter.  The 
parts  being  separated,  the  ovary  seemed  to  be  sufficiently 
isolated,  and  could  be  seized  without  much  difficulty  for 
extirpation,  it  now  being  certain  that  the  disorganization 
was  irreparable. 

"The  operation  was  simple,  and  included  the  applica- 
tion of  a  tenaculum  to  the  upper  part  of  the  tumor  (the 
hardened  ovary),  which  fixed  it,  and  facilitated  the  entire 
dissection  without  injury  to  the  surrounding  parts. 

"  From  a  branch  of  the  spermatic  artery  there  was  a  little 
hemorrhage  immediately  after  the  extirpation,  but  it 
seemed  to  me  of  no  great  moment.     A  small  bit  of  dry 


IN  FRANCE.  ~2j 

charpie,  secured  with  a  thread,  as  well  as  balls  of  the  same, 
with  which  I  filled  the  sac  of  the  Fallopian  tube,  after  hav- 
ing saturated  them  with  the  yellow  of  an  egg,  one-third 
honey,  were  all  that  was  necessary  for  the  internal  treat- 
ment. Emollient  embrocations  to  the  abdomen,  covered 
with  lint,  over  all  of  which  poultices  were  applied,  con- 
stituted the  external  treatment. ' ' 

The  morning  after  the  operation  the  patient 
was  very  weak,  answering  questions  only  by 
"yes  and  no,"  but  to  use  M.  L'Aumonier's  own 
words,  "  the  purulent  discharge  from  the  vulva 
was  absolutely  dried  up." 

On  the  third  day  he  made  the  following"  ob- 
servations  regarding  the  internal  treatment  of 
the  abscess  that  was  indicated  : 

"I  learned  why  the  intestines  do  not  present  at  the 
opening,  as  often  happens  in  large  incisions  penetrating 
the  abdomen.  I  readily  discovered  the  causes  of  this — 
they  are  adhesions,  resulting  from  inflammation  between 
the  circumference  of  the  tumor  and  the  peritoneum,  which 
I  have  wished  to  overcome  in  order  to  avoid  the  pain  they 
often  occasion,  from  traction  upon  them,  after  the  cure  of 
the  disease  giving  rise  to  them.  I  felt  too  great  a  resist- 
ance, and  the  patient  too  much  pain,  to  push  further  the 
slight  attempts  that  I  made.  I  contented  myself  with 
treating  the  bottom  of  the  ulcer  with  the  small  balls  of 
charpie  and  the  lint  over  the  abdomen,  medicated  as  pre- 
viously described." 

The  progress  of  the  improvement  was  unin- 
terrupted until  the  sixteenth  day  after  the 
operation,   when    the    patient  was  seized   with 


328 


MCDOWELL'S  OPERATION 


an  hysterical  convulsion  which  lasted  several 
hours,  though  she  appeared  to  come  out  of  it 
all  right.  This  was  followed  by  the  catamenia. 
On  the  second  day  of  the  flow  the  discharge 
from  the  wound  was  tinged  with  blood,  the 
explanation  of  which  M.  L'Aumonier  was  not 
able  to  give — that  is,  as  to  whether  it  was  men- 
strual or  came  from  the  sides  of  the  granulating 
wound.  He  recognized,  however,  that  the  tinge 
gradually  ceased  with  the  menstrual  flow.  "At 
this  stage  the  cavity  of  the  Fallopian  tube  was 
reduced  to  about  the  size  of  an  egg."  The 
wound  completely  cicatrized  without  any  fistula 
remaining,  and  the  patient  was  discharged 
cured,  February  20,  1782. 

Mr.  L'Aumonier  concludes  the  report  of  his 
case  in  these  words  : 

"  This  example  and  that  of  total  amputation  of  the  uterus 
and  vagina  performed  with  success,  justify  the  conclusion 
that,  with  a  thorough  knowledge  of  anatomy,  there  are  but 
few  organs  upon  which  one  may  not  perform  with  advan- 
tage the  different  operations  of  surgery. " 

About  twenty-five  years  after  the  report  of 
L'Aumonier's  case  was  published  (1 782-1807), 
the  Inaugural  Thesis  of  M.  d'Ischier,  at  Mont- 
pellier,  appeared  in  defence  of  the  success  of 
this  operation  as  one  of  real  extirpation  of  the 
ovary,   coupled  with    the    success  of  a  similar 


IN  FRANCE.  329 

operation  in  a  case  by  M.  Kapeler ;  but,  accord- 
ing to  Velpeau,  as  has  been  shown,  the  efforts 
of  the  author  failed  to  impress  the  profession 
with  the  importance  he  attached  to  these  cases 
and  their  results.  In  this  connection  Velpeau 
does  not  even  so  much  as  quote  the  publication 
of  L'Aumonier,  or  allude  in  the  slightest  way 
to  any  of  the  circumstances  attending  the 
operation  he  performed,  thus  leaving  the 
reader  wholly  in  doubt  as  to  the  source  of 
M,  d'Ischier's  information  upon  the  subject. 

This  brings  us  to  a  still  longer  lapse  (1807— 
1837)  of  almost  total  neglect,  in  France,  of  the 
treatment  of  ovarian  dropsy,  as  the  history  of 
the  subject  would  seem  to  prove.  Notwith- 
standing the  inauguration  and  recognized  suc- 
cess by  the  McDowell  procedure  during  this 
period  in  other  countries,  the  first  evidence  we 
have  of  the  revival  of  interest  in  the  subject  in 
France  is  found  in  the  proposal  of  M.  Mon- 
teggia.  The  evidence  regarding  Monteggia  is 
based  upon  the  high  authority  of  Professor 
Malgaigne,1  who  regards  his  proposal  as  only 
a  slight  modification  of  that  described  in  the 
report  of  a  case  by  William  Jeaffreson,  Esq.,  of 

1  Manuel  de  Medecine  Operatoire.     Trans,  by  Dr.  Frederick 
Brittan,  1846. 


o^o  MCDOWELL'S  OPERATLON 

England.  The  following  is  a  description  of 
Monteggia's  proposal,  as  given  by  Professor 
Malgaig-ne : 

"  This  surgeon  objects  principally  to  the  large  incisions 
of  the  abdomen.  He  advises  puncturing  the  tumor  with  a 
large  trocar,  and  extracting  the  liquid;  and  then,  after 
having  somewhat  enlarged  the  opening,  if  necessary,  intro- 
ducing long-branched  forceps,  like  those  of  Hunter  for 
the  extraction  of  calculi  from  the  urethra.  By  means  of 
these  forceps  he  forcibly  seizes  the  sac,  thus  emptied, 
draws  it  outside,  and  then  excises  it  near  its  base ;  apply- 
ing to  its  pedicle  a  ligature,  the  two  ends  of  which  are 
brought  out  of  the  wound  so  as  to  be  withdrawn  when  the 
remainder  of  the  sac  is  completely  detached  and  removed." 

Tn  connection  with  the  above  proposal  of 
Monteggia,  M.  Malgaigne  describes  the  mode 
of  treating  encysted  dropsy  by  incisionism  asso- 
ciated with  the  name  of  Le  Dran  (i  736-1 746), 
and  later  with  that  of  Galenzowski  (1827)  ;  and 
of  treating  hernia  of  the  ovary  by  excision,  as 
coupled  with  the  name  of  Deneux.  He  also 
describes  the  proposal  of  Theden  for  extirpa- 
tion of  the  ovary,  and  the  actual  operation  of 
McDowell  for  the  same  purpose,  but  cites  no 
instance  in  which  either  had  ever  been  em- 
ployed in  France.  In  the  latter  connection  he 
says  : 

"We  find  traces  of  this  operation  in  divers  authors  ;  but 
the  first  who  framed  an  operative  proceeding  that  he  in- 


IN  FRANCE. 


331 


tended  adopting  was  Theden  (between  1750  and  1760), 
and  the  first  who  performed  it  seems  to  have  been  Mc- 
Dowell (1809)." 

As  to  the  further  history  of  the  treatment  of 
ovarian  dropsy  in  France,  I  must  again  refer 
to  Professor  Velpeau1  as  the  best  authority. 
For  an  explanation  of  the  character  of  this 
treatment  it  is  only  necessary  to  state  that  an 
attempt  was  made  in  a  case  by  M.  Recamier  to 
establish  drainage  with  a  seton  through  the 
vagina  ;  and  in  another  case,  by  M.  Marjolin, 
with  an  injection  of  honeyed  barley  water  (eau 
d'orge  meillee),  both  in  the  year  1839,  and 
both  terminated  fatally. 

From  all  that  has  been  said  thus  far  upon 
the  history  of  extirpation  of  the  ovary  for  the 
cure  of  ovarian  dropsy,  in  France,  it  appears 
that  not  a  single  operation  up  to  this  date  was 
performed  there  according  to  the  teachings  of 
McDowell.  As  proof  upon  this  point  I  would 
refer  to  the  communication  entitled  "  Ouelques 
notes  relatives  a  Pexcision  des  tumeurs  ova- 
riques,"  Par  Achille  Chereau,  D.M.P.2 

This  writer,  in  his  remarks  introductory  to 
his  Table  of  Statistics,  speaks  as  follows  : 

1  Op.  cit. 

2  Journal  des  Connaissances  Medico-Chirurgicales,  1844,  t.  i. 
p.  228. 


232  MCDOWELL'S  OPERATION 

"I  will  say  at  the  outset  that  one  need  not  expect  to 
find  in  the  following  lines  an  apology  for,  nor  a  criticism 
upon,  the  operation  forming  the  subject  of  this  article. 
They  are  simply  notes  from  extracts  that  I  have  read  of 
the  estimate  of  it  in  French  publications,  and  from  which 
it  is  my  sole  aim  to  briefly  show  the  present  state  of  the 
science  relative  to  the  excision  of  tumors  of  the  ovaries. 
According  to  my  knowledge,  the  attempts  which  have 
been  made  up  to  the  present  time  to  remove,  in  totality, 
tumors  situated  in  the  ovaries,  amount  to  sixty-five,  of 
which  cases  the  appended  Table  shows  the  circumstances." 

The  writer  excludes  from  this  Table  the  case 
of  L'Aumonier,  and  assigns  his  reason  for  it  in 
these  words : 

"In  that  number  I  do  not  include  the  case  reported  by 
L'Aumonier,  as  has  been  done  erroneously,  in  my  opinion, 
by  all  the  authors  who  have  written  upon  this  subject.  If 
that  surgeon  did  perform  the  ablation  of  one  of  the  ovaries, 
it  was  performed  in  a  fortuitous  manner,  as  it  were,  and  on 
account  of  the  disorganization  of  that  organ." 

Even  at  the  date  of  the  publication  of  this 
Table  of  Statistics,  by  M.  Chereau  (1844),  two 
years  after  the  revival  of  the  operation  of  Mc- 
Dowell in  England,  he  does  not  include  a  case 
operated  upon  in  France  by  this  procedure. 
Of  the  sixty-five  cases  given  we  find  the  follow- 
ing distribution  of  them,  as  to  the  countries  in 
which  these  operations  were  performed  :  Great 
Britain,  37  cases;  Germany  15  cases;  United 
States,  8  cases  ;  anonymous,  5  cases. 


IN  FRANCE. 


333 


Comments. — The  points  brought  out  in 
our  study  of  the  early  history  of  ovarian 
dropsy  in  France  show  a  wide  range  of  in- 
vestigation with  regard  to  the  nature,  origin, 
diagnosis,  prognosis,  and  treatment  of  this 
disease  by  the  incisionist ;  and  are  of  far 
greater  interest  than  would  seem  from  a 
cursory  glance  at  the  subject.  Le  Dran,  as 
we  have  seen,  during  the  few  years  (1736-46) 
that  he  devoted  to  the  study  and  investigation 
of  these  several  aspects  of  the  subject,  accom- 
plished much  that  was  of  real  value .  toward 
advancing  the  prevailing  knowledge  at  that 
period.  The  disease  was  then  called  scirrhus 
by  all  writers,  and  Le  Dran  so  described  it, 
believing  the  origin  and  seat  of  it  to  be  inside 
of  the  sac,  at  or  near  its  base,  the  attachment 
of  the  ovary  to  the  uterus,  or  in  one  or  both 
iliac  fossae  ;  also,  that  the  growth  of  the  disease 
depended  upon  the  gradual  enlargement  up- 
ward of  a  single  cyst.  The  growth  of  the  dis- 
ease he  also  knew  to  be  confined  at  first  to  one 
side,  and  that  as  the  growth  gradually  extended 
it  occupied  both  sides,  thus  showing  by  these 
observations  accuracy  in  differential  diagnosis, 
and  the  importance  he  attached  practically  to 
being  always   able  to  determine    the    side    on 


004  MCDOWELL'S  OPERATLON 

which  the  disease  was  seated.  For  the  ordinary- 
operation  of  tapping  he  was  influenced  by  these 
considerations,  and  in  the  advance  from  this 
practice  to  that  of  incisionism  he  adhered  even 
more  strictly  to  the  observance  of  the  same 
general  rule. 

From  the  known  result  in  nearly,  if  not  all, 
cases  in  which  tapping  was  performed,  he  saw 
that  the  sac  would  refill  sooner  or  later  (in  from 
a  few  weeks  to  several  months),  necessitating  a 
repetition  of  the  operation  in  order  to  relieve 
the  distressed  breathing  and  the  embarrassed 
functions  of  the  body  generally,  and  by  which 
alone  death  could  be  averted  for  a  time. 

With  this  knowledge  of  the  nature,  seat, 
growth,  and  consequences  of  such  tumors,  he 
dared  to  make  incisions  below  the  umbilicus,  by 
which  the  peritoneal  cavity  was  laid  open  in  its 
lower  division  ;  to  carry  the  finger  or  the  hand, 
as  the  case  might  be,  into  the  abdomen  and 
pelvis  in  search  of  disease  ;  and  to  leave  the 
cavity  open  for  the  employment  of  drainage 
and  injections,  by  tent  and  tubes,  as  has  been 
shown.  In  this  way  he  actually  cured,  to  all 
intents  and  purposes,  one  case  that  he  operated 
upon,  the  patient  remaining  in  a  fair  state  of 
health,  with  only  a  fistulous  opening,  for  four 


IN  FRANCE.  335 

years  ;  and  in  another  he  completed  the  cure 
without  a  remaining  fistula.  In  the  first  case  he 
made  a  small  incision  in  the  right  side,  four 
inches  in  length,  admitting  about  two  fingers 
for  exploration,  using  afterward  drainage-tubes 
and  injections  ;  but  after  six  months,  finding  an 
increased  growth  of  the  tumor,  he  made  across 
the  lower  part  of  the  abdomen  an  incision  six 
or  seven  inches  in  length,  admitting  the  whole 
hand  for  exploration,  and  allowing  of  the  same 
general  after-treatment  by  tent,  drainage-tube, 
and  injections.  In  the  second  case  he  found 
the  enlargement  of  two  years'  standing,  occupy- 
ing both  sides  of  the  abdomen,  and  he  tapped 
it.  When  the  fluid  was  drawn  off  he  discovered 
a  scirrhous  tumor,  the  size  of  a  "melon,"  on  the 
left  side,  and  at  the  end  of  three  weeks  the 
abdominal  distention  was  as  great  as  ever ; 
whereupon,  he  decided  to  lay  the  abdomen  and 
tumor  open.  This  time  he  selected  the  linea 
alba  below  the  umbilicus  for  his  incision,  ex- 
tending it  to  the  pubes,  with  the  intention,  as  he 
tells  us,  that  the  opening  in  the  abdominal  wall 
should  not  close  up  promptly,  in  order  that  the 
cyst  itself  might  have  time  to  contract,  and  the 
lower  angle  of  the  opening  made  in  it  be  kept 
always  near  the  angle  of  the  external  wound 


o->6  MCDOWELL'S  OPERATLON 

and  the  bottom  of  the  sac,  the  scirrhous  seat  of 
the  disease.  In  this  way  he  was  better  enabled 
to  employ  his  drainage-tube  and  injections  to 
favor  inflammation  and  suppuration  of  the  walls 
of  the  cyst. 

Le  Dran's/ theory  of  the  treatment  employed 
in  the  above  two  cases  was  based  upon  former 
observations  and  experience,  and  his  logical 
explanation  of  it,  before  he  undertook  the  ope- 
rations in  question,  accorded  most  fully  with  the 
results  which  he  achieved. 

The  final  result  in  the  second  case,  as  we 
have  seen,  was  a  complete  triumph  for  the 
method  of  incisionism,  without  a  remaining  fis- 
tula. Had  the  tumor  in  the  case  not  been  a 
multilocular  cyst,  and  complicated  with  adhe- 
sions, as  was  probably  the  case,  Le  Dran,  with 
the  incision  he  made,  might  have  had  a  very 
different  termination  of  the  primary  operation, 
to  wit :  the  result  of  a  spontaneous  protrusion 
of  the  collapsed  cyst  through  the  abdominal 
opening,  and  a  division  by  him  of  the  pedicle, 
thus  giving  to  the  world  an  operation  of  com- 
plete extirpation  of  a  dropsical  ovary — the 
achievement  left  to  McDowell  just  sixty-three 
years  later  (1809). 

Le  Dran,  although  anticipated  over  a  third  of 
a  century  in  the  employment  of  incisionism  by 


IN  FRANCE. 


\Z7 


Houston,  may  properly  be  regarded  as  the  first 
to  fully  comprehend  and  master  the  principle  of 
the  procedure,  and  thus  to  be  able  to  secure  its 
fullest  fruition.  For  this  the  profession  in  his 
own  country,  and  in  all  others  as  well,  owe  him 
more  credit  for  the  really  scientific  work  he  did, 
and  for  the  triumph  which  he  secured  from  it, 
than  it  is  believed  he  has  ever  received. 

The  four  cases  following  Le  Dran's  are  all 
of  interest,  as  we  have  seen,  illustrating,  as  they 
do,  important  points  in  regard  to  the  origin  and 
seat  of  encysted  dropsies,  and  especially  the 
first  one  (that  of  M.  Mouton),  in  which  the 
accumulation  of  fluid  took  place  between  the 
peritoneum  and  abdominal  muscles,  attaining 
enormous  dimensions,  and  causing  the  death  of 
the  patient,  while  on  her  knees,  the  only  posi- 
tion in  which  she  had  been  able  to  breathe  for 
two  or  three  weeks  previously.  In  another  case 
(that  of  M.  De  La  Chaud),  the  fluid  forming  the 
tumor  was  found  between  the  folds  of  the  peri- 
toneum. Next  we  have  the  case  of  M.  Montau- 
lieu,  in  which  the  tumor  was  of  a  "  cauliflower 
form,"  being,  probably,  of  papillomatous  origin  ; 
and,  lastly,  that  of  M.  Malaval,  in  which  both 
ovaries  were  involved,  and  a  correct  diagnosis 
made,  as  was  proved  afterward  by  the  autopsy. 


oog  MCDOWELL'S  OPERATION 

Next  is  the  important  case  of  M.  Delaporte, 
from  the  peculiarities  of  which,  as  we  have  seen, 
he  was  led,  after  his  attempt  at  removal  by  in- 
cision simply,  to  inquire,  for  the  first  time  in 
the  history  of  the  treatment  of  ovarian  dropsy : 
Would  it  not  be  possible  "to  remove  the  focus 
of  the  disease — namely,  the  tumor  formed  by 
the  ovary  ?" 

In  this  instance  Delaporte  encountered  a 
semi-solid  tumor,  no  doubt  multilocular  in 
character,  of  enormous  dimensions,  and  with 
no  recognized  features  to  indicate  which  ovary 
was  involved.  The  greater  prominence,  how- 
ever, of  the  enlargement  of  the  left  side  no 
doubt  influenced  him  to  make  his  incision  here, 
and  it  was  commenced  just  above  the  anterior 
superior  spine  of  the  ilium  and  extended  up- 
ward and  inward  the  length  of  five  fingers' 
breadth.  There  is  no  evidence  that  Delaporte 
at  any  time  introduced  his  finger  or  fingers 
through  the  opening  for  the  purpose  of  explor- 
ing the  interior  of  the  tumor ;  and  the  reason 
for  this,  no  doubt,  was  that  the  gelatinous  fluid 
it  contained  poured  out  in  such  continuous 
quantities  that  there  was  no  opportunity  to  do 
it.  He  contented  himself  with  simply  looking 
on  and  noting  the   enormous  discharge  from 


IN  FRANCE.  ,3g 

day  to  day,  until  the  thirteenth,  when  the  patient 
expired,  the  wound  having  given  issue  to  sixty- 
seven  pounds  of  fluid.     At  the  autopsy  Dela- 
porte  found  that  the  tumor  involved  the  right 
ovary,  instead  of  the  left,  where  the  incision  was 
made — precisely  the  same   obstacle  to  success 
by  incision  that  Le   Dran  encountered  in  his 
first  operation.    The  latter  mistake  in  diagnosis, 
and  consequently  the  error  in  puncturing  the 
abdomen  in  the  wrong  place,  was  made  by  the 
physician  previously  in  charge.     This  error  of 
diagnosis   and  the  unguided  puncture  on  the 
right  side  gave  rise,  no  doubt,   in   Le  Dran's 
second  operation  in  the  same  case,  to  the  long 
transverse  incision  he  was  forced  to  make,  ex- 
tending from  the  point  of  this  puncture  to  the 
left  side,  the  actual   seat  of  the  tumor.     Had 
the  diagnosis  of  the  seat  of  the   disease  been 
correct  in   Delaporte's   case,   and   the  incision 
made  into  the  tumor  on  the  right  side,  instead 
of  the  left,  near  its  base,  the  probability  is  that 
all  of  the  fluid  would  have   escaped  in   a  far 
shorter  time.    Thus  would  the  chances  of  saving 
the  life  of  his  patient  have  been  increased  to  a 
certain  extent ;  and  by  enlarging  his  incision  to 
admit  the  hand  into  the  interior  of  the  tumor 
for   breaking   up    the   partitions    between    the 


34<D  MCDOWELL'S  OPERATION 

minor  cysts,  as  Le  Dran  did  for  diagnostic  pur- 
poses in  his  second  operation,  he  would  have 
increased  his  chances  still  more,  probably  to 
the  extent  of  removing  the  entire  diseased  mass 
at  the  time  of  his  operation.  But,  after  all,  it 
was  no  doubt  his  error  of  diagnosis  as  to  the 
ovary  involved,  and  the  great  disadvantage  ex- 
perienced from  making  the  incision  so  far  from 
the  base  of  the  tumor,  that  led  Delaporte  after- 
ward to  institute  the  inquiry  he  did  as  to  the 
preferableness  of  the  incision  being  made  over 
the  focus"  of  the  disease,  and  of  the  removal  of 
the  affected  organ  in  totality. 

Of  the  originality  of  the  proposal  of  Dela- 
porte there  seems  to  be  no  question.  Certainly 
there  is  no  evidence  accessible  to  show  that  he 
was  acquainted  with  the  Eastern  custom  of  re- 
moving normal  ovaries  in  women  mentioned 
by  Lisfranc ;  or  that  he  was  influenced  by  the 
well-known  expedient  of  removing  the  ovaries 
in  the  female  of  quadrupeds  which  has  come 
down  to  us  from  former  centuries  ;  nor  is  there 
any  reason  to  believe  that  he  was  at  all  familiar 
with  the  discussions  upon  the  same  subject  by 
Schlenker,  Willius,  Peyer,  and  Targioni,  claimed 
by  Velpeau  to  have  taken  place  during  the 
thirty  years  previously  (i 722-1 752). 


IN  FRANCE.  ,41 

Delaporte  makes  no  mention  of  the  work  of 
Le  Dran,  as  appears  from  the  history  of  his 
case  and  operation  ;  but  no  one  can  fail  to  see 
that  he  was  a  strict  follower  of  the  latter  as 
regards  the  procedure  of  incisionism. 

A  fact  deserving  emphasis  in  this  connection 
is  that  the  four  incisions  made  in  the  three 
cases  of  Le  Dran  and  Delaporte,  distinctive  of 
the  old  method  of  incisionism,  were  restricted 
to  the  lower  division  of  the  abdomen  alone  (a 
line  extending  across  the  longitudinal  axis  of 
the  body,  at  the  umbilicus,  being  the  limit),  and 
were  of  variable  length.  These  incisions  for 
convenience  in  description  may  be  divided  into 
the  short  and  the  medium.  One  of  them  on 
the  right  side  was  four  inches  long  ;  one  of  them 
on  the  left  was  made  four  inches  at  first,  and 
then  extended  somewhat  into  the  medium,  one 
reaching  from  four  to  six  inches  in  the  linea 
alba  up  to  the  umbilicus,  and  another  medium 
or  long,  reaching  transversely  from  the  right  to 
the  left  side  and  six  or  seven  inches  in  extent. 
These  incisions,  all  in  the  lower  division  of  the 
abdomen,  as  stated,  and  made  without  refer- 
ence to  the  axis  of  the  body,  except  in  one  in- 
stance, constitute  the  most  important  feature 
of  the  old  method  of  incisionism.     The  one  of 


042  MCDOWELL'S  OPERATION 

Le  Dran,  however,  which  extended  transversely 
across  the  body,  without  regard  to  the  direction 
of  muscles  or  the  course  of  large  bloodvessels, 
was  made  in  a  most  unjustifiable  way. 

Theden's  scheme  of  extirpating  a  dropsical 
ovary,  an  extension  of  incisionism,  was  unques- 
tionably the  outcome  of  Delaporte's  proposal. 
It  was  characterized  by  a  short  incision  four 
inches  long  in  the  inguinal  region,  as  he  sup- 
posed the  diseased  ovary  to  be  outside  the 
peritoneum.  After  exposing  the  organ  and 
giving  vent  to  the  contained  fluid  he  would 
draw  the  cyst  out,  put  a  ligature  on  its  point  of 
attachment,  and  cut  it  away.  The  tumor  on 
being  found  hard,  and  not  susceptible  of  being 
drawn  out  and  excised,  was  to  be  seized  with 
the  fingers  and  forcibly  brought  out.  Suffice 
it  to  say  that  this  was  merely  a  theory  as  to 
what  the  author  thought  an  operation  ought  to 
be  for  the  purpose  indicated.  It  is,  however, 
of  interest  here  to  refer  to  it,  for  the  reason 
that  it  excited  no  little  attention  in  France  at 
the  time  of  its  proposal,  was  extolled  by  Mo- 
rand,  and  by  two  English  surgeons,  Power  and 
Darwin,  and  was  even  favorably  commented 
upon  by  Malgaigne,  as  late  as  1842,  as  the 
first   scheme  proposed    for  extirpation  of  the 


IN  FRANCE.  343 

ovary,   while    McDowell's   procedure  was    the 
completion  of  it. 

L'Aumonier  performed  his  operation  from 
thirty  to  forty  years  (1782)  after  the  proposal 
of  extirpation  of  the  ovary  by  Delaporte,  and 
the  plan  of  executing  it  as  formulated  by  The- 
den.  L'Aumonier's  operation  forms  an  im- 
portant era  in  the  history  of  incisionism  in 
France,  as  we  have  seen,  and  requires  more 
than  a  passing  notice.  It  was  performed  upon 
a  young  woman,  aged  twenty-one,  six  or  seven 
weeks  after  an  attack  of  puerperal  peritonitis, 
resulting  as  the  facts  show,  in  a  pelvic  abscess 
which  opened  from  Douglas's  pouch  into  the 
vagina,  the  most  favorable  of  the  four  common 
outlets  of  such  purulent  accumulations.  L'Au- 
monier, finding  a  tumor  of  considerable  hard- 
ness in  the  hypogastric  region,  and  perceiving 
that  pressure  upon  this  region  caused  sudden 
and  repeated  gushes  of  matter  from  the  vulva, 
concluded  erroneously  that  an  abscess  of  the 
ovary  existed,  which  had  opened  into  the  cor- 
responding Fallopian  tube,  whence  the  pus 
escaped  through  the  uterus  and  vagina.  The 
external  uterine  orifice,  he  averred,  from  a  dioi- 
tal  examination,  to  be  in  a  normal  state.  His 
operation,     based    upon    this    theory    of    the 


•344  MCDOWELL'S  OPERATLON 

enlargement  he  found  in  the  hypogastric  re- 
gion, consisted,  as  we  have  seen,  in  making  an 
incision  over  the  prominent  part  of  the  dis- 
tended region  (tumor)  four  inches  in  length, 
running  obliquely  across  the  linea  alba,  the  side 
of  the  affected  ovary  not  being  mentioned. 
The  bluish  fluctuating  tumor  found  at  the  bot- 
tom of  his  incision,  after  dilatation  with  the 
fingers,  he  says,  was  attached  below,  over  the 
inguinal  ring  of  the  affected  side,  and  floating 
above,  while  it  was  surmounted  by  another  little 
tumor  the  size  of  an  egg,  having  a  hard  feeling 
{tumeur  skirrheuse).  Below  this  latter  point 
he  plunged  his  bistoury  (this  being  the  second 
step  of  the  procedure),  extending  the  division 
of  the  structures  down  to  the  angle  formed  by 
the  Fallopian  tube  of  the  corresponding  side 
with  the  uterus,  and  thus  gave  vent  to  a  pint 
of  blackish  and  most  offensive  purulent  fluid. 
His  next  step  was  the  introduction  of  his  finger, 
to  its  full  length,  into  the  wound,  and  this  re- 
sulted in  the  discovery,  as  he  says,  in  the  upper 
side  of  the  cavity  of  "an  excavation  in  the  body 
of  the  ovary  of  which  the  borders  were  of  con- 
siderable hardness,"  corresponding  in  situation 
almost  precisely  with  the  hard-feeling  little 
tumor  surmounting  the    bluish   tumor,  as  de- 


IN  FRANCE.  345 

scribed.  The  small  opening  through  which  his 
finger  passed  to  reach  this  point  led  him  to 
reconsider  his  first  opinion  regarding  this  hard- 
feeling  little  tumor.  The  result  was,  he  dis- 
covered, as  he  states,  that  the  small  opening 
mentioned,  with  "hardened  borders,"  was  the 
outlet  of  an  abscess  in  the  ovary,  and  that  the 
"  organ  was  disorganized  beyond  reparation. 
But  in  this  reinvestigation  of  the  parts  involved 
he  overlooked  the  fact  that  the  fluctuating  little 
bluish  tumor,  fixed  below,  floating  above,  and 
surmounted  by  the  hard-feeling  little  tumor, 
still  remained  unexplained.  The  seizing  of  the 
disorganized  ovary,  with  "hardened  borders," 
with  a  tenaculum,  the  removal  of  it  entire  by 
dissection  without  injury  to  the  surrounding 
parts,  and  with  a  loss  of  only  a  few  drops  of 
blood,  all  tend  to  prove  the  operation  to  have 
been  not  only  complex  and  unique,  but  of  a 
character  bordering  on  the  marvellous.  Such 
a  procedure,  without  any  explanation  of  the 
character  of  the  specimen  so  removed,  cannot, 
however,  be  accepted  as  justifying  the  import- 
ance given  to  it  by  L'Aumonier,  to  say  nothing 
of  the  inconsistency  of  his  statements  regarding 
the  anatomical  and  pathological  structures  in- 
volved, and    their  relations  one  with  another. 


346  MCDOWELL'S  OPERATION 

The  claim,  therefore,  of  an  abscess  of  the  ovary 
emptying  into  the  corresponding  Fallopian 
tube,  and  of  the  extirpation  of  the  diseased 
organ,  it  must  be  said,  is  not  only  opposed  by 
the  vague  pathological  description  of  the  struct- 
ures implicated,  but  by  sound  principles  of 
surgery. 

It  is  clear  enough,  from  what  we  have  read  of 
L'Aumonier's  description,  and  the  analysis  here 
made  of  the  different  steps  of  his  operation, 
that  the  true  explanation  is  that  given  in  the 
outset,  viz.  :  that  the  enlargement  found  in  the 
hypogastric  region  was  nothing  more  or  less 
than  a  pelvic  abscess  in  Douglas's  space,  result- 
ing from  puerperal  peritonitis,  with  rupture  of 
the  pouch,  and  discharge  through  the  vagina. 

The  proof  of  the  above  explanation  is,  on  the 
one  hand,  the  impossibility  of  L'Aumonier's 
forcing  out  in  sudden  and  repeated  gushes  a 
purulent  fluid  through  the  Fallopian  tube,  the 
uterus,  and  its  external  orifice,  in  a  normal  state, 
as  he  describes  ;  and,  on  the  other  hand,  of  the 
entire  practicability  of  his  being  able  to  do  this 
easily  by  the  same  manipulation  with  the  open- 
ing that  existed  between  the  bottom  of  Dou- 
glas's pouch  and  the  vagina.  Besides,  the 
extirpation  of  the  hard-feeling  little  tumor  sur- 


IN  FRANCE.  347 

mounting  the  large  bluish  tumor  actually  con- 
taining the  purulent  fluid,  without  reference  to 
the  walls  of  the  tumor,  would  have  been  impos- 
sible, as  described,  and  his  claim  of  successful 
removal  of  a  disorganized  ovary  is  therefore 
clearly  absurd. 

As  another  proof  of  the  absurdity  of  L'Au- 
monier's  having  even  discovered,  to  say  nothing 
of  his  removing,  a  disorganized  ovary  indepen- 
dent of  the  walls  of  the  sac  containing  the  pus, 
it  is  only  necessary  to  assume  (which  is  in  strict 
accordance  with  his  description)  that  the  upper 
part  of  the  large  cavity  was  bounded  by  the 
broad  ligament  and  the  fundus  of  the  uterus, 
the  latter  being  drawn  over  to  the  affected  side 
by  adhesions.  This  being  understood,  it  is 
easy  to  see  that  the  hardened  substance  finally 
recognized  in  the  sac,  claimed  by  him  to  have 
been  seized  with  the  tenaculum  and  removed, 
was  not  the  disorganized  ovary  at  all,  but  the 
fundus  of  the  uterus.  Whether  he  dissected 
out  this  "without  injury  to  the  surrounding 
parts"  remains,  in  my  opinion,  an  open  question. 

From  this  it  follows  that  the  small  opening 
admitting  L'Aumonier's  finger  was  nothing 
more  or  less  than  the  point  of  communication 
between  two    parts  of  the  large  bluish  tumor 


548  MCDOWELL'S  OPERATLON 

actually  containing  the  pus,  one  being  on  the 
affected  side  of  the  uterus,  and  the  other  in 
Douglas's  pouch ;  and  that  when  he  passed  his 
finger  through  the  small  opening  into  the  cavity 
of  the  ovary,  as  he  supposed,  he  simply  passed 
it  under  the  fundus  of  the  uterus  into  Douglas's 
pouch,  thus  showing  the  continuity  of  the  two 
portions  of  this  cavity,  viz. :  the  bluish-looking 
tumor,  or  pus  sac,  which  he  had  cut  down  upon 
in  the  outset  of  his  operation  and  punctured. 
By  so  doing  he  gave  vent  to  the  pint  of  con- 
tained pus,  and  caused  the  "  drying  up "  the 
day  afterward  of  the  purulent  vaginal  discharge, 
as  he  describes. 

In  justice  to  L'Aumonier,  however,  it  is 
proper  to  state  that  the  incision  made  by  him 
for  the  relief  and  cure  of  his  case  of  pelvic 
abscess  was  simply  an  extension  of  the  principle 
of  incisionism  as  employed  by  Houston  and 
Le  Dran,  especially  in  the  first  case  of  the  lat- 
ter, nearly  fifty  years  previously.  In  the  result 
thus  achieved  by  him  of  completely  emptying 
Douglas's  pouch  by  the  procedure  described, 
and  thus  curing  his  patient,  is  to  be  found  his 
triumph,  which  was  truly  brilliant  for  his  day, 
and  would  even  do  credit  to  the  most  advanced 
laparotomist  of  the  present  time. 


IN  FRANCE. 


349 


In  this  connection  it  is  also  proper  to  state 
that  in  the  various  references  made  by  subse- 
quent writers  to  L'Aumonier's  case  there  has 
been  an  extraordinary  reticence,  and  conse- 
quently a  misunderstanding  regarding  its  diag- 
nosis, and  the  precise  character  of  the  operation 
he  performed.  Hence  the  non-appreciation  of 
the  operation  as  to  its  true  merits,  not  as  a 
procedure  of  extirpation  of  the  ovary,  so  erro- 
neously claimed  for  him,  but  as  a  practical 
extension  of  the  procedure  of  incisionism  to  the 
relief  and  cure  of  pelvic  abscesses,  and  a  de- 
monstration of  its  availability  in  other  serious 
conditions,  such  as  tubal  pregnancy,  pyosal- 
pinx,  etc.,  to  the  value  of  which  the  attention 
of  the  profession  has  only  been  pointedly 
directed  within  the  last  decade. 

Again,  as  we  have  seen,  twenty-five  years 
after  the  publication  of  L'Aumonier's  case,  the 
claim  of  successful  extirpation  of  the  ovary  by 
the  latter  was  revived,  in  the  Inaugural  Thesis 
of  M.  d'Ischier,  in  connection  with  the  success 
of  Kapeler's  case,  and  the  fact  that  the  date  of 
this  thesis  was  only  two  years  before  that  of 
McDowell's  first  operation  also  proved  preju- 
dicial to  the  recognition  Gf  McDowell's  claims, 
from  the  constant  references  made  to  the  sub- 


or0  MCDOWELL'S  OPERA TLOJV 

ject  at  that  time,  and  the  want  of  knowledge  of 
the  real  facts  of  the  case — M.  d'Ischier,  instead 
of  L'Aumonier,  being  usually  referred  to  by 
authors.  This  was  done  even  by  Velpeau 
himself. 

Of  all  the  French  writers  that  have  been  con- 
sulted in  connection  with  this  subject  only  one 
has  been  found  (M.  Chereau)  who  quotes 
directly  from  the  publication  of  L'Aumonier's 
case,  as  recorded  in  the  Histoire  de  la  Societe 
Roy  ale  de  Medecine,  1782-83. 

In  concluding  these  comments,  I  would  state 
that  during  all  these  years  of  the  history 
of  McDowell's  operation  (the  period  of  our 
present  study  of  the  subject,  1809-42)  not  a 
single  report  of  an  operation  according  to  this 
procedure  has  been  found  in  the  medical  litera- 
ture of  France.  The  question  may  well  be 
asked:  What  was  the  cause  of  this  seeming 
neglect  of  the  procedure  ?  Could  it  have  been 
from  dissatisfaction  with  the  character  and 
results  of  the  few  operations  performed  during 
the  period  of  the  old  procedure  by  incisionism ; 
or  did  it  result  from  the  failure  of  surgeons,  for 
all  these  years,  to  regain  sufficient  confidence 
to  make  the  trial  of  a  different  and  more  pro- 
mising operation  ? 


IN  GERMANY.  35! 

SECTION    III. 

Germany. 

A  great  deal  has  been  said  of  Professor 
Dzondi,  of  Halle,  and  the  association  of  his 
name  with  ovariotomy.  In  the  United  States 
Dr.  Nathan  Smith,  in  the  report  of  his  success- 
ful case  of  ovariotomy  (1822),  refers  to  Dzondi's 
practice  of  incision  and  drainage  ;  and,  evidently 
impressed  with  the  importance  of  his  views 
upon  the  subject,  disclaims  any  knowledge  of 
them  prior  to  the  date  of  his  operation.  Dr. 
W.  L.  Atlee  places  his  name  in  his  "Table  of 
Statistics"  (185 1),  before  that  of  McDowell  as  a 
successful  ovariotomist.  In  England  Mr.  John 
Lizars,  in  his  paper  entitled  "  Observations  on 
the  Extirpation  of  the  Ovaria,  with  Cases," 
published  in  1824,  speaks  of  Dzondi's  successful 
treatment  of  dropsical  ovaries.  Velpeau,  at  a 
still  later  date,  mentions  the  plan  of  treatment 
ascribed  to  Dzondi  by  Mr.  Lizars,  but  calls 
attention  to  the  contradictory  statement  upon 
the  subject  by  Dr.  Dolhoff,  of  Magdeburg, 
Prussia,  a  pupil  of  Dzondi. 

As  to  the  real  facts  relating  to  the  credit 
attributed  to  Dzondi  in  the  United  States  and 


,c2  MCDOWELL'S  OPERATION 

in  England,  as  above  shown,  a  reference  to  his 
published  work,  entitled :  Beitraege  zur  Ver- 
volkommung  der  Heilkunde  (1816),  an  Eng- 
lish review1  of  which  I  have  consulted,  shows 
that  the  practice  attributed  to  Dzondi  did  not 
relate  to  the  treatment  of  dropsical  ovaries  at 
all,  but  to  that  of  encysted  dropsy  ("hydrops 
succatus  peritonei ")  in  the  case  of  a  boy, 
Christopher  Shultz,  twelve  years  of  age.  The 
operation  he  performed  was  simply  a  puncture 
with  a  trocar  of  the  distended  abdomen,  which 
was  made  in  the  presence  of  Dr.  Funke,  May 
24,  18 1 4.  After  the  fluid  was  drawn  off  he  en- 
larged the  trocar  puncture  by  incision,  and 
"  introduced  into  the  orifice  a  large  linen  tent 
dipped  in  oil,  and  secured  it  externally  by  ad- 
hesive plaster."  The  tent  was  removed  every 
other  day,  the  size  being  gradually  increased 
until  the  twenty-sixth  day  after  the  operation, 
when  a  ragged  point  of  the  cyst  wall  showed 
itself  at  the  fistulous  orifice,  and  was  seized  with 
a  pair  of  forceps  and  entirely  drawn  out,  piece 
by  piece.     The  patient  recovered. 

The  reviewer  of  Professor  Dzondi's  work 
says  of  the  principle  of  the  treatment  employed 
in  the  above  case,  that  it  "  might  be  resorted  to 

1  Am.  Med.  Recorder,  1820,  vol.  iii.,  p.  57. 


IN  GERMANY.  353 

with  equal  success  in  ovarian  dropsy,  as  soon 
as  the  sack  lies  between  the  peritoneum  and 
the  external  covering  (muscular  wall),  as  is 
generally  the  case,  and  if  the  ovary  itself  has 
not  yet  entered  into  an  ulcerated  and  scirrhous 
state."  This  theory  of  the  ovaries  being  out- 
side of  the  peritoneum  will  be  recognized  as  the 
same  taught  by  Theden  in  France,  1753-1760. 

Thus  is  made  clear  what  was  actually  pro- 
posed and  accomplished  by  Dzondi  in  a  case  of 
encysted  dropsy  in  a  boy ;  but  it  is  also  evident, 
from  the  presentation  of  the  subject  of  incision- 
ism  in  France,  where  it  was  practised  nearly 
three-quarters  of  a  century  earlier,  that  Dzondi 
had  profited  from  the  teachings  of  the  incision- 
ists  there,  and,  consequently,  was  entitled  to 
no  claim  of  originality  of  the  employment  of  the 
principle  further  than  as  regards  its  extension 
by  applying  it  to  the  successful  treatment  of 
encysted  dropsy  other  than  ovarian. 

Let  us  next  see  with  what  success  McDow- 
ell's operation  of  ovariotomy  by  his  long  inci- 
sion was  first  employed  by  German  surgeons, 
from  the  results  as  set  forth  in  the  recorded 
cases  of  Chrysmar,  Martini,  DiefTenbach,  Ehr- 
hartstein,  Quittenbaum,  Dolhoff,  Groth,  Chriss- 
man,  Ritter  and  Stilling. 
23 


254  MCDOWELL'S  OPERATIOX 

To  Dr.  Chrysmar,  of  Isny,  in  Wurtemberg, 
is  justly  due  the  credit  of  having  been  the  first 
in  Europe  to  perform  McDowell's  operation, 
although  he  is  credited  by  Dr.  Hopfer,  of  Biber- 
bach,  with  having  been  the  first  anywhere  to 
perform  extirpation  of  a  dropsical  ovary,  since 
no  mention  is  made  by  him  of  the  American 
operation.  The  facts  are,  that  Chrysmar's  first 
case,  reported  by  Dr.  Hopfer,  bears  the  date  of 
May  1 6,  1819 — nearly  ten  years  after  McDow- 
ell's first  operation,  and  more  than  two  years 
after  the  publication  of  his  first  three  cases 
(181 7).  Beside  this,  Chrysmar's  first  recorded 
cases  bear  the  ear-marks  of  the  long  peritoneal 
incision,  the  full  exposure  of  the  peritoneal 
cavity,  and  the  bringing  out  in  the  lower  angle 
of  the  wound  the  ends  of  the  ligature  on  the 
pedicle,  which  are  themselves  enough  to  prove 
beyond  the  shadow  of  a  doubt  the  priority  of 
the  American  operation,  independent  of  Dr. 
Hopfer's  statements,  dates,  or  publications. 
Dr.  Hopfer,  in  his  report  of  Chrysmar's  three 
cases,  entitled :  "  On  Extirpation  of  Diseased 
Ovaria,"1  states  the  circumstances  under  which 
he  became  acquainted  with  Dr.   Chrysmar  and 

1  Monthly  Journ.  of  Foreign  Med.,  1829,  vol  iii.,  p.  440;  trans- 
lated from  Medicinische-chirurgische  Zeitung,  Feb.,  1827. 


IN  GERMANY. 


355 


the  results  of  his  operations.  In  1 8 19,  as  Medi- 
cal Superintendent,  he  went  to  Allgau,  in  the 
district  of  Swabia,  where  Chrysmar  enjoyed  a 
wide  reputation,  and  had  already,  as  he  learned, 
performed  two  operations,  one  of  which  was 
successful.  Hopfer  says  that  during  his  three 
years'  residence  in  Swabia  Dr.  Chrysmar  per- 
formed three  operations  for  extirpation  of  dis- 
eased ovaria,  two  of  which  he  witnessed,  and 
the  third  of  which  was  a  case  of  his  own 
(Hopfer's). 

Case  I. — Mrs.  Leupalz,  aged  forty-seven,  presented  her- 
self to  Dr.  Chrysmar  with  a  hard  tumor  in  her  left  side, 
about  the  size  of  a  child's  head,  complicated  with  ascites. 
The  operation  was  performed  May  16,  1819.  The  long 
incision  of  McDowell  was  adopted,  extending  in  the  linea 
alba  from  the  ensiform  cartilage  to  the  pubes,  with  full 
exposure  of  the  abdominal  cavity.  Extensive  adhesions 
were  found  between  the  tumor  and  the  arch  of  the  de- 
scending and  transverse  colon,  as  well  as  the  great  arch  of 
the  stomach.  The  ligature  was  brought  out  at  the  lower 
angle  of  the  wound.  Patient  expired  thirty-six  hours  after 
the  operation.  The  diseased  ovarium  weighed  seven  and 
a  half  pounds.  Its  surface  was  irregular  and  knotty,  and 
upon  section  its  structure  was  of  a  cartilaginous  and  fibrous 
character,  with  small  "intervening  cavities,  filled  with 
greenish  offensive  sanies." 

Case  II. — A.  B.,  aged  forty,  presented  herself  with  a 
tumor,  the  size  of  a  child's  head,  in  the  left  side,  with  dis- 
tinct fluctuation,  and  anasarca  of  the  lower  extremities. 
In  June,  1820,  Dr.  Chrysmar  performed  the  operation  in 
the  presence  of  Dr.  Bawnwarth  and  three  other  surgeons. 
The  long  incision  was  employed,  as  in  the  preceding  case, 


356 


MCDOWELL'S  OPERATLON 


with  full  exposure  of  the  abdominal  cavity.  No  adhesions. 
Wound  closed  with  sutures,  and  the  ends  of  the  ligature  on 
the  pedicle  brought  out  at  the  lower  angle  of  the  wound. 
The  tumor  weighed  eight  pounds.  Patient  returned  home 
well  at  the  end  of  six  weeks. 

Case  III. — A  single  woman,  of  Bavaria,  named  Schei- 
deck,  aged  thirty-eight,  with  abdominal  tumor,  spinal 
curvature,  and  deformed  pelvis,  applied  to  Dr.  Hopfer  in 
1820  for  treatment,  but  he  advised  her  to  consult  Dr. 
Chrysmar.  The  latter  decided  to  make  the  operation  for 
removal  of  the  tumor,  which  he  did  in  the  presence  of  Dr. 
Hopfer  and  three  assistants.  The  long  incision  was  made, 
with  full  exposure  of  the  abdominal  cavity.  There  were 
slight  adhesions,  but  the  pedicle  was  found  to  be  short  and 
four  inches  thick.  It  was  tied  with  a  double  ligature, 
wound  closed  with  sutures,  and  ligature  brought  out  at  the 
lower  angle  of  the  wound.  Death,  preceded  by  convul- 
sions, took  place  at  the  end  of  thirty-six  hours.  "Tumor 
weighed  six  pounds  and  a  half,  and,  on  being  divided,  pre- 
sented a  lardaceous  texture,  with  numerous  fibrous  cysts, 
filled  with  a  brownish  stuff,  like  size." 

Next  follow  two  cases  operated  upon,  respec 
tively,  by  Dr.  E.  Martini  and  Prof.  Dieffenbach. 

Case  IV. — Woman,  aged  twenty-four,  with  enlarge- 
ment of  her  left  side,  believed  by  her  former  physician  to 
be  due  to  an  ovarian  tumor,  consulted  Dr.  Martini  in 
April,  1827.  She  had  previously  been  tapped  four  times, 
the  last  time  only  a  month  before  her  admission,  at  which 
date  the  cavity  of  the  cyst  was  injected  with  water  and 
alcohol  in  the  proportion  of  8  :  1.  Dr.  Martini,  at  a  fifth 
tapping,  made  two  punctures  at  the  same  sitting  to  relieve 
distention ;  after  which  he  decided  to  make  an  incision  in 
the  linea  alba  three  inches  below  the  umbilicus.  This 
incision  was  then  enlarged  above  and  below  to  the  extent 
of  nine  inches  (McDowell's  incision).     The  tumor  was  the 


IN  GERMANY. 


357 


size  of  a  man's  head,  round,  smooth,  and  of  a  "  cartilagi- 
nous consistence,"  and  it  seemed  solidly  fixed  in  the  brim 
of  the  pelvis.  He  could  not  find  the  pedicle.  In  the 
upper  part  of  the  tumor  there  was  a  large  cyst  which  was 
punctured  and  evacuated,  the  canula  being  left  in  it  to 
insure  drainage.  Wound  closed  with  sutures,  the  canula 
projecting  from  the  line  of  union.  Case  terminated 
fatally  seventy-two  hours  after  the  operation.  Disease 
was  found  seated  in  the  left  ovary,  as  diagnosticated. 

Case  V. — A  Polish  woman,  aged  forty,  after  having 
been  examined  by  a  number  of  surgeons,  finally  consulted 
Prof.  Dieffenbach  in  regard  to  a  large  tumor  in  the  abdo- 
men, which  she  believed  resulted  from  a  blow  received  ten 
or  twelve  years  previously.  Prof.  Dieffenbach  decided  to 
operate,  and  made  the  long  incision,  extending  along  the 
linea  alba  to  the  pubes  (McDowell's  incision).  The 
lower  part  of  the  tumor,  and  its  relations  to  the  uterus 
and  bladder  could  not  be  made  out  —  it  having  a 
broad  base  and  seeming  to  be  attached  to  the  vertebral 
column.  It  was  somewhat  round,  of  a  bluish  color,  and 
of  almost  cartilaginous  hardness,  and  contained  large 
bloodvessels.  The  puncture  in  the  tumor  was  followed  by 
profuse  bleeding,  which  could  be  controlled  only  by  com- 
pression. It  was  deemed  proper  not  to  attempt  a  removal 
of  the  tumor.  Wound  closed  by  sutures.  Patient  re- 
covered.1 

The  following   is  a  short  abstract  of  a  case 

reported  by  Dr.  Ehrhartstein,2  translated  from 

the  Med.  yahr.  des  Oester  Staats  : 

Case  VI. — Mrs.  A.  D.,  aged  thirty-one,  in  her  fifth 
pregnancy  showed  enormous  abdominal  distention,  which 
was  but  little  diminished  after  her  delivery.  The  cause  of 
this  was   soon  after  discovered  to  be  enlargement  of  the 

1  Archives  Generales  de  Medecine,  1829,  t.  20. 

2  Medico-Chirurg.  Rev.,  July,  1833,  vol.  xix. 


358 


MCD O WELL'S  OPERA  TION 


right  ovary  ;  the  case  thus  illustrating  the  possibility  of 
such  tumors  becoming  complicated  with  pregnancy.  The 
cyst  was  partially  relieved  by  puncture  with  the  trocar 
and  the  abstraction  of  fourteen  pounds  of  fluid ;  where- 
upon another  similar  cyst  was  discovered,  and  a  second 
puncture  made,  giving  vent  to  twelve  pounds  more  of 
fluid ;  thus  proving  the  tumor  to  be  multilocular.  The 
operation  was  performed  eighteen  weeks  after  delivery. 
The  length  of  the  incision  is  not  stated,  but  presumably 
the  long  incision  was  employed,  from  the  facility  with 
which  the  existing  adhesions  were  overcome  and  the  opera- 
tion completed — only  fifteen  minutes  being  required  for 
the  purpose.  Ligatures  were  applied  to  three  bleeding 
vessels,  but  special  treatment  of  the  pedicle  is  not  men- 
tioned. It  is  to  be  inferred,  however,  that  the  ligatures 
were  brought  out  at  the  lower  angle  of  the  wound,  since  it 
is  stated  that  the  threatening  febrile  symptoms  intervened, 
which  were  only  relieved  on  the  eighth  day  by  a  discharge 
from  the  wound,  "of  bloody  serum  and  gas."  The 
emptied  tumor  weighed  twelve  pounds,  and  was  found  to 
be  composed  of  numerous  cavities.  The  patient  was  dis- 
charged cured  at  the  end  of  nine  weeks. 

Case  VII. — All  the  details  of  the  case  of  Dr.  Quitten- 
baum,  next  in  order,  are  not  accessible,  but  the  writer  has 
been  able  to  ascertain  that  he  performed  the  operation 
November  18,  1834,  and  that  his  incision  was  four  inches 
in  length.  The  cyst  was  successfully  removed,  and  the 
patient  made  a  complete  recovery. 

Dr.  Dolhoff,1  of  Magdeburg,  Prussia,  in  a 
communication  entitled  "On  the  Puncture  and 
Extirpation  of  Tumefied  Ovaries,"  makes  two 
divisions  of  ovarian  cysts,  requiring  two  differ- 

1  L'Experience,  1837-38,  t.  i.  p.  625;  from  Rust's  Magazin, 
1838,  1st  series,  vol.  li. 


IN  GERMANY.  org 

ent  plans  of  treatment,  viz. :  first,  unilocular 
cyst,  with  puncture  by  trocar,  incision,  tent  and 
injections  (incisionism)  ;  and,  second,  multilob- 
ular cyst,  with  incision  and  extirpation.  He 
encountered  two  cases  of  the  first  variety, 
which  were  treated  by  incisionism  with  injec- 
tions of  red  wine,  a  weak  solution  of  nitrate  of 
mercury,  etc.,  and  both  of  which  terminated 
fatally  (1829-33).  Of  the  second  variety 
(multilocular)  he  relates  three  cases.  In  the 
outset  he  speaks  of  the  difficulty  of  diagnosis 
and  the  justifiability  of  the  operation  in  this 
class  of  cases.  He  refers  to  Prof.  Dieffen- 
bach's  case,1  in  which  there  was  a  mistake  in 
the  diagnosis,  and,  consequently,  failure  to 
remove  the  existing  tumor.  In  two  of  Dol- 
hoff's  cases  the  tumor  was  removed,  and  in  the 
third  no  tumor  was  found. 

Case  VIII. — Maria  Bock,  aged  twenty-three,  after  an 
attack  of  tertian  intermittent  fever,  in  1832,  first  noticed  a 
swelling  in  the  left  side.  Little  by  little  this  tumor  in- 
creased in  size  until  the  spring  of  1833,  when,  after  receiv- 
ing various  opinions  upon  her  case,  she  applied  to  Dr. 
Dolhoff,  and  was  admitted  to  the  hospital  at  Magdeburg. 
The  girth  of  the  abdomen  was  then  fifty-three  inches,  and 
the  condition  was  attended  by  great  embarrassment  in 
breathing.  The  tumor  was  irregular,  and.  hard  under 
pressure,  fluctuation  being  very  obscure.  Dr.  Dolhoff 
called  for  a  consultation  with  his  colleagues  upon  the  case, 

1  Rust's  Magazin,  vol.  xxv. 


360 


MCDOWELL'S  OPERATION. 


and  there  was  great  diversity  of  opinion  as  to  the  true 
character  of  the  tumor.  He  himself  believed  the  disease 
to  be  ovarian.  It  was  agreed  by  all  that  the  tumor  should 
be  punctured,  as  it  was  thought  that  this  would  throw  more 
light  upon  the  diagnosis.  Dr.  Dolhoff  found,  however,  that 
the  abdominal  wall  was  so  thick  everywhere  except  in  the 
lower  part,  where  there  was  risk  of  wounding  the  bladder 
from  puncture  with  a  trocar,  that  he  decided  to  first  make 
an  incision  into  the  peritoneal  cavity,  and  then  puncture 
the  cyst.  The  point  of  election  was  to  the  left  of  the 
umbilicus,  where  the  surface  was  more  elevated  than  else- 
where, and  here  a  perpendicular  incision,  two  inches  in 
length,  was  made  through  the  muscular  wall.  (Sept.  27, 
1833.)  After  a  considerable  quantity  of  ascitic  fluid  had 
escaped  through  the  wound  a  puncture  was  made  in  the 
tumor,  but  only  a  little  dark,  thick  fluid  escaped  ;  where- 
upon the  abdominal  wound  was  enlarged,  and  an  incision 
made  into  the  cyst  wall,  found  to  be  about  an  inch  thick, 
and  the  contained  fluid,  of  a  gelatinous  character,  evacu- 
ated. The  hand  was  next  introduced,  and  the  contents 
broken  up  and  removed  as  far  as  possible.  A  large  portion 
of  the  posterior  cyst  wall  (about  the  size  of  a  man's  hand) 
was  seized  with  forceps,  drawn  out,  and  cut  off.  It  still 
being  found  that  the  tumor  could  not  be  removed  from  the 
abdominal  cavity,  the  external  incision  was  enlarged  to  the 
extent  of  seven  or  eight  inches  (McDowell's  long  incision), 
when  the  diseased  mass  became  more  movable,  and  was 
readily  lifted  out  through  the  wound,  there  being  no  adhe- 
sions. The  pedicle  was  found  to  be  the  size  of  the  little 
finger,  and  was  included  in  a  strong  ligature.  After  cut- 
ting away  the  tumor  Dr.  Dolhoff  discovered  the  orifices  of 
two  arteries  in  the  end  of  the  divided  pedicle,  about  the 
size  of  a  crow's  quill,  and,  fearing  that  his  ligature  might 
slip  off,  he  tied  each  artery  separately,  and  removed  the 
ligature,  including  the  pedicle  in  mass,  thus  guarding  more 
effectually,  as  he  believed,  against  secondary  hemorrhage. 
He  does  not  so  state,  but  it  is  to  be  inferred,  that  he  cut  the 


IN  GERMANY.  36 1 

ligatures  off  close  to  the  knots,  as  the  irritation  likely  to 
result  from  the  ends  of  the  ligatures  would  be  an  additional 
reason  for  his  change  in  the  mode  of  treating  the  pedicle. 
The  wound  was  closed  with  sutures,  and  the  patient  died 
sixty  hours  after  the  operation  from  extensive  peritonitis, 
as  was  found  at  the  autopsy  ;  though  the  symptoms  up  to 
the  time  of  death  did  not  indicate  this  lesion,  a  circum- 
stance thought  to  be  very  extraordinary  by  Dr.  Dolhoff 
and  his  colleagues.  The  tumor  and  its  contents  weighed 
forty-six  and  one-half  pounds. 

Case  IX. — Emilie  Rcettcher,  aged  twenty-seven,  ad- 
mitted to  the  hospital  at  Magdeburg,  September  28,  1833, 
with  a  tumor  in  the  left  side  of  the  abdomen,  felt  by  the 
patient  to  be  movable  from  side  to  side,  and  believed  by 
her  to  have  resulted  from  a  blow.  Dr.  Dolhoff  made  an 
examination,  and  found  the  tumor  to  be  a  little  larger  than 
a  child's  head,  of  globular  form,  and  pushed  toward  the 
right  side.  Operation  October  21,  1833.  A  medium 
incision  was  made  in  the  linea  alba,  from  the  umbilicus  to 
the  pubes,  but  this  being  found  too  small,  it  was  extended 
two  inches  above  the  former.  (McDowell's  long  incision.) 
This  brought  to  view  a  hard  tumor,  covered  above  by  the 
omentum,  and  containing  bloodvessels  enormously  en- 
larged, and  numerous  little  growths  of  a  whitish  and  bluish- 
red  color,  while  below  it  was  solidly  fixed  in  the  pelvis, 
rendering  introduction  of  the  hand  impossible.  From  the 
condition  thus  revealed  an  attempt  at  removal  was  deemed 
unjustifiable,  and  the  wound  was  closed  in  the  usual  way 
with  sutures,  etc.  The  patient  died  eight  hours  afterward. 
At  the  autopsy  the  tumor  was  found  to  fill  the  pelvis,  and 
to  be  firmly  united  by  adhesions  to  the  pelvis,  uterus, 
bladder,  rectum,  and  both  ovaries,  and  it  was  not  possible 
to  determine  in  which  of  these  organs  the  growth  had 
originated. 

Dr.  Dolhoff,  in  commenting-  upon  the  above 
case,    says   that,  although    the   growth   of  the 


362  MCDOWELL'S  OPERATLON 

tumor  was  of  short  duration,  and  the  sensation 
of  the  tumor,  as  described  by  the  patient,  was 
as  if  it  fell  from  side  to  side,  the  diagnosis  as 
regards  its  mobility  proved  to  be  wholly  faulty, 
and  the  removal  of  the  tumor  practically 
impossible. 

In  the  introduction  to  his  third  case  of  peri- 
toneal section  Dr.  Dolhoff,4n  a  most  commend- 
able way,  states  that  it  illustrates  a  grave  error 
in  diagnosis,  and  the  unjustifiability  of  the  ope- 
ration he  performed.  He  says  he  delayed  for 
some  time  before  reporting  the  case,  thinking 
it  would  be  ridiculed.  But,  conscientiously 
believing  it  to  be  the  duty  of  every  surgeon  to 
report  his  mistakes  as  well  as  his  triumphs,  he 
could  not  in  this  instance  depart  from  the  rule, 
consoling  himself  with  the  knowledge  that  he 
was  not  alone  in  the  world  in  his  particular, 
since  a  celebrated  surgeon  had  already  pub- 
lished a  similar  experience.  (His  reference 
here  being  to  the  unfortunate  case,  in  Great 
Britain,  of  Mr.  John  Lizars.) 

Case  X. — Friederike  Gollner,  aged  twenty- three,  un- 
married, after  an  obstinate  attack  of  tertian  intermittent 
fever  in  1835,  of  which  she  was  cured  by  large  doses  of 
quinine,  suffered  from  retention  of  urine  (with  varying 
quantities  of  mucous  and  purulent  deposits  in  the  urine 
drawn  off),  requiring  the  use  of  the  catheter  three  or  four 


IN  GERMANY. 


363 


times  a  day.  There  was  also  obstinate  constipation  of  the 
bowels,  for  the  relief  of  which,  at  times,  three  drops  of 
croton  oil  would  be  used.  Following  this  condition  of 
things  the  patient,  after  several  months,  began  to  have 
tenderness  in  the  lower  part  of  the  abdomen.  This  ten- 
derness was  soon  succeeded  by  distention  of  the  abdomen, 
gradually  extending  itself  to  and  above  the  umbilicus, 
which  would  alternately  become  more  or  less  effaced  and 
then  salient.  With  the  increase  of  the  vesical  trouble  and 
the  abdominal  tenderness  and  distention,  a  hard  rounded 
body,  seemingly  the  size  of  a  foetus,  was  discovered  occu- 
pying principally  the  epigastric  region.  Dr.  Dolhoff,  after 
consultation  with  his  colleagues,  all  of  whom  agreed  that 
the  enlargement  was  due  to  the  presence  of  ovarian  disease, 
decided  to  remove  the  tumor.  He  performed  the  opera- 
tion September  29,  1836,  making  a  medium  incision  in  the 
linea  alba,  from  the  umbilicus  to  the  pubes.  On  intro- 
ducing his  hand  into  the  abdomen  and  carefully  searching, 
however,  he  could  not,  to  his  own  astonishment  and  that 
of  his  colleagues,  discover  any  tumor.  The  wound  was 
closed  with  sutures  in  the  usual  way,  and  the  patient  made 
a  speedy  recovery. 

In  commenting  upon  the  result  of  his  first 
case,  Dr.  Dolhoff  congratulates  himself  upon 
applying  his  ligatures  separately  to  the  two 
arteries  found  in  the  pedicle,  thus  guarding  his 
patient  against  the  additional  danger  of  hemor- 
rhage by  the  ligature  slipping  off  the  pedicle. 
He  calls  the  attention  of  the  profession  to  this 
method  of  treating  the  pedicle,  and  in  this  con- 
nection refers  to  the  history  of  an  operation 
performed  by  Dr.  Groth,  whose  name  appears 


364 


MCDOWELL'S  OPERATION 


in  several   of  the    statistical  tables    published, 
though  without  comments. 

Case  XL — A  woman  named  Waswo,  of  Schonmoor, 
consulted  Dr.  Groth  in  regard  to  an  enlargement  on  the 
left  side  of  the  abdomen,  which  he  attributed  to  a  dropsical 
condition  of  the  left  ovary.  He  recommended  the  extir- 
pation of  the  diseased  organ,  and  to  this  the  patient  readily 
consented.  The  operation  was  performed  in  1833,  but  the 
kind  of  incision  is  not  mentioned  in  the  account  of  his 
operation,,  though  it  is  believed  to  have  been  the  long. 
The  pedicle  was  encircled  with  a  ligature  in  the  usual  way, 
and  the  tumor  removed.  The  patient  died  six  hours  after 
the  operation  from  secondary  hemorrhage,  which  is  be- 
lieved by  Dr.  Dolhoff  to  have  been  caused  by  the  slipping 
of  the  ligature  from  the  pedicle. 

Case  XII. — Of  the  case  of  Dr.  Ritter  (1833),  which  is 
referred  to  by  statistical  writers,  the  details  are  not  accessi- 
ble, and  all  that  is  known  in  regard  to  it  is  that  he  em- 
ployed the  long  McDowell  incision,  and  successfully 
removed  a  fluid  cyst,  with  no  adhesions,  and  weighing 
twelve  pounds. 

Case  XIII. — This  is  Dr.  Stilling's  case,1  and  here  again 
there  is  a  lack  of  details.  We  learn,  however,  from  the 
Statistical  Table  of  Mr.  Phillips,  that  an  incision  (medium) 
was  made  six  inches  in  length,  that  no  adhesions  were 
found,  and  that  the  patient  died  from  hemorrhage. 

Case  XIV. — The  case  of  Dr.  Chrissman  is  included  in 
the  Tabular  Statement  of  Mr.  Benjamin  Phillips  (1844), 
but  the  date  of  his  operation  is  not  given,  though  it  is 
placed,  chronologically,  before  that  of  Mr.  Jeaffreson 
(1836),  in  England.  Of  the  character  of  his  operation  it 
may  be  stated  that  he  employed  McDowell's  long  incision, 
found  no  adhesions,  removed  a  tumor  weighing  twenty-two 
and  a  half  pounds,  and  cured  his  patient. 

1  Holcher's  Hanoversche  Annalen,  1841,  Heft  3. 


IN  GERMANY.  365 

Summary  of  cases  and  results  in  Germany, 
including  the  two  of  Dr.  Chrysmar  referred  to 
by  Dr.  Hopfer,  but  not  reported  :  12  completed 
operations  with  5  cures  and  7  deaths  ;  3  unfin- 
ished operations  with  1  recovery  and  2  deaths  ; 
1  unjustified  operation  with  recovery.  Mortal- 
ity of  complete  operations  58.33  per  cent. 

Comments. — This  completes  the  history,  as 
far  as  it  can  be  ascertained,  of  McDowell's 
operation  in  Germany  as  regards  its  initiatory 
trial  in  sixteen  cases  (1819-1841).  Two  cases 
of  Dr.  Chrysmar,  in  addition  to  his  three  re- 
ported cases,  are  included  in  my  summary  upon 
the  authority  of  Dr.  Hopfer,  who  states  that 
one  of  them  was  cured  and  one  terminated 
fatally,  making  in  all  for  Dr.  Chrysmar  five 
cases,  with  two  successes  and  three  deaths.  It 
is  proper  to  mention  that  McDowell's  work  is 
not  alluded  to  in  connection  with  a  single  one 
of  these  sixteen  cases,  so  far  as  I  have  been 
able  to  learn,  and  that  the  only  way  by  which  I 
have  been  enabled  to  trace  the  influence  of  his 
teachings  upon  the  surgeons  performing  these 
operations  has  been  through  careful  study  of 
his  long  incision,  and  the  extension  of  the  short 
or  medium  incision  into  the  long,  together  with 
another  distinctive   feature   of  his  procedure : 


,66  MCDOWELL'S  OPERATION 

that  of  bringing  out  both  ends  of  the  ligature 
on  the  pedicle  in  the  lower  angle  of  the  wound. 
Just  how  Dr.  Chrysmar,  in  the  little  town  of 
Isny,  in  the  Kingdom  of  Wurtemberg  (1819), 
obtained  his  first  information  regarding  the 
reports  of  McDowell's  first  three  cases,  two 
years  after  their  publication  in  the  Philadelphia 
Eclectic  Repertory  (181 7),  it  would  be  difficult 
to  say  ;  when  in  the  United  States  Dr.  Nathan 
Smith,  Professor  of  Surgery  in  Yale  Medical 
College,  at  New  Haven  (a  little  over  one 
hundred  and  fifty  miles  from  Philadelphia,  and 
in  close  connection  with  the  latter),  had  not 
apparently  read  or  heard  of  McDowell's  bril- 
liant operations  at  the  time  when  he  (Smith) 
performed  his  first  operation  of  extirpation  of 
-an  ovary  two  years  later  (182 1).  And  yet 
the  facts  clearly  show  that  Dr.  Chrysmar  had 
not  only  obtained  this  information  in  the  face 
of  the  many  obstacles  then  existing  to  inter- 
communication between  foreign  countries  ;  but, 
on  the  authority  of  Dr.  Hopfer,  Medical  Super- 
intendent at  Allgau,  in  1819,  he  had  even  then 
already  performed  two  operations,  one  with 
success  ;  making,  as  stated,  with  the  three  other 
reported  cases  after  this  date  (18 19—1820),  five 
cases,  precisely  the  same  number  that  McDow- 


IN  GERMANY.  367 

ell  had  reported  in  his  two  papers  embracing 
the  period  between  1809  and  1819.  Dr.  Chrys- 
mar's  results  in  these  rive  cases  (two  cures  out 
of  the  five),  though  far  short  of  those  achieved 
by  McDowell  (three  cures  out  of  five  cases)  in 
the  far  off  little  village  of  Danville,  in  the  back- 
woods of  Kentucky,  certainly  show  a  very  fair 
average  of  success.  If  nothing  more,  they  in- 
dicate an  earnest  and  determined  effort  on  his 
part  to  rescue  a  large  class  of  women  from  a 
disease  nearly  always  fatal,  and  hitherto  left  to 
the  chances  of  incisionism,  which  then  only  was 
practised,  and  that  only  to  a  limited  extent,  in 
England  and  France.  To  Chrysmar,  therefore, 
honor  is  due  next  to  McDowell,  and  a  position 
assignable  to  no  other  surgeon  in  Germany  or 
any  other  country  outside  of  the  United  States, 
and  even  here  outside  of  the  State  of  Kentucky, 
since  to  Chrysmar  properly  belongs  the  credit 
of  having  been  the  first  to  catch  the  inspiration 
of  the  "Father  of  Ovariotomy"  and  to  place 
his  convictions  of  the  soundness  of  the  princi- 
ples of  the  operation  before  the  eyes  of  the 
profession  of  his  own  country,  which,  as  the 
history  of  the  subject  shows,  was  not  'done  by 
any  one  else  there  until  seven  years  later 
(1827).      Such    boldness  and   daring  as  were 


368  MCDOWELL'S  OPERATION 

displayed  by  Chrysmar  in  these  first  trials  of 
ovariotomy,  under  the  circumstances  stated,  are 
deserving  of  the  highest  acknowledgment — yea, 
of  a  monument  to  perpetuate  the  nobleness  of 
his  example  and  the  influence  of  it  on  his  kind. 
May  we  not  hope  yet  to  see  the  high  apprecia- 
tion of  the  deeds  of  this  truly  great  surgeon  and 
their  value  commemorated  by  the  liberality  of 
the  profession  of  Germany  ?  A  monument  has 
been  erected  at  Danville  to  the  name  and  honor 
of  the  "  Father  of  Ovariotomy  "  by  the  grateful 
profession  of  his  own  State,  Kentucky,  and  one 
now  erected  to  the  memory  of  Chrysmar,  the 
first  to  appreciate  and  perform  ovariotomy  any- 
where outside  the  State  of  Kentucky,  would 
not  only  be  a  praiseworthy  act  on  the  part  of 
the  profession  of  his  own  country,  but  it  would 
show  a  just  appreciation  of  the  claim  properly 
belonging  to  the  little  town  of  Isny,  near  the 
border  of  Bavaria,  and  one  of  the  free  cities  of 
Germany  from  1365  to  1803,  in  which  this 
historic  achievement  took  place. 

To  the  other  operations  performed  in  Ger- 
many there  is  no  special  interest  attached, 
except  in  the  cases  of  Drs.  Ehrhartstein  and 
Dolhoff.  The  case  of  the  former,  it  will  be 
remembered,  was  the  one  in  which  the  compli- 


IN  GERMANY.  ogg 

cation  of  pregnancy  occurred,  giving  rise  to 
enormous  distention  of  the  abdomen.  Soon 
after  labor,  in  which  there  is  no  special  men- 
tion of  difficulty,  tapping  was  performed  and 
two  distinct  cysts  evacuated ;  the  fluid  from  one 
weighing  twelve,  and  from  the  other  fourteen 
pounds.  From  the  circumstances  there  might 
have  been  inferred  implication  of  both  ovaries, 
the  possibility  of  which  had  been  shown  in 
France  some  two-thirds  of  a  century  previously 
by  an  autopsy  made  by  M.  Malaval.  Here 
there  was  likewise  large  and  uniform  disten- 
tion of  the  abdomen,  resulting  from  ascitic 
effusion  into  the  peritoneal  cavity  surrounding 
the  two  separate  ovaries.  This  pair  of  ovaries 
weighed,  respectively,  twelve  and  fifteen  pounds 
— figures  corresponding  almost  precisely  with 
those  given  by  Dr.  Ehrhartstein,  and  making  a 
very  extraordinary  coincidence. 

About,  or  soon  after,  the  period  referred  to 
in  France  (1753),  Morand,  in  commenting  upon 
dropsical  ovaries  and  the  several  varieties  then 
known  to  exist,  speaks  of  the  complication, 
sometimes,  of  the  disease  with  pregnancy.  He 
even  cites  a  case  in  which  the  complication 
took  place  three  times  without  any  impairment 
of  the  general  health,  though  the  third  gesta- 
24 


oyo  MCDOWELL'S  OPERATIOX 

tion  failed  to  reach  its  full  term.  After  this  (at 
the  end  of  the  fourth  year)  the  patient  was 
tapped  and  twenty-five  pints  of  fluid  drawn  off. 
In  this  connection  the  writer  recalls  a  case1  of 
complicating  pregnancy  he  operated  upon  six 
or  eight  years  ago,  in  which  the  long  incision  of 
McDowell  again  proved  of  inestimable  value. 
Here  the  complication  not  only  co-existed  with- 
out impairment  of  the  general  health  or  diffi- 
culty in  the  labor,  but  the  patient  afterward 
nursed  her  child  up  to  the  time  she  applied  for 
the  removal  of  the  tumor,  five  or  six  weeks 
after  labor.  She  was  then  of  the  size  of  a 
woman  at  full  term,  and  the  result  of  the  oper- 
ation was  all  that  could  have  been  wished  con- 
sidering the  existence  of  still  another  grave 
complication  that  was  found  seriously  to  inter- 
fere with  the  execution  of  the  procedure.  This 
second  complication  consisted  of  a  calcareous 
deposit  in  the  walls  of  the  cyst,  about  one-third 
the  size  of  the  hand,  to  which  was  firmly  adhe- 
rent a  coil  of  small  intestine.  So  firmly  glued 
together  were  the  peritoneal  surfaces  at  this 
point  that  separation  was  found  impossible. 
The  difficulty,  however,  was  overcome  by  split- 
ting the  cyst  wall,  the  scalpel  being  made  to 
follow  closely  upon  the  external  surface  of  the 

1  Transactions  Texas  State  Medical  Association,  for  1885. 


IN  GERMANY.  37! 

calcareous  plate.  In  this  way  the  correspond- 
ing part  of  the  cyst  wall  was  detached  and  left 
in  its  pathological  relations  with  the  intestine, 
to  take  care  of  itself  afterward  in  the  abdo- 
men ;  which  it  did  with  no  ulterior  bad  conse- 
quences, as  proved  by  the  final  good  result. 

Dr.  Dolhoff  refers  to  five  cases  (two  uniloc- 
ular and  three  multilocular),  together  with  one 
of  false  diagnosis  in  which  an  operation  was 
unwarrantably  performed.  The  interesting 
point  regarding  the  treatment  of  the  first  class 
of  cases  named  is  that  he  employed  the  old 
method  of  incisionism  with  drainage  and  injec- 
tions. In  this  connection  he  speaks  of  using 
injections  of  red  wine  and  a  weak  solution  of 
nitrate  of  mercury ;  and  both  cases  in  which 
they  were  tried  terminated  fatally  (1829-33). 
The  general  plan  pursued  by  him  differed  but 
little  from  that  of  Prof.  Dzondi  (18 16),  he 
having  been  a  pupil  of  the  latter  for  several 
years,  and,  of  course,  familiar  with  his  practice. 
It  is  in  this  connection  that  he  avers  most  posi- 
tively that  Prof.  Dzondi  entertained  no  special 
views  upon  the  treatment  of  encysted  dropsy 
of  the  ovaries,  as  claimed  for  him  by  Mr..  John 
Lizars,  and  he  expresses  his  surprise  that  the 
latter  should  ever  have  made  a  statement  so 
erroneous. 


2^2  MCDOWELL'S  OPERATLON 

In  two  of  the  three  cases  of  multilocular 
cysts  referred  to  by  Dolhoff  there  are  several 
interesting  points  brought  out.  The  first  case 
presented  a  girth  of  fifty-three  inches,  and  the 
tumor  was  uneven  and  more  or  less  hard,  with 
no  distinct  fluctuation  at  any  point.  From 
these  and  other  peculiarities  of  the  tumor  and 
its  surroundings,  puncture  of  it  with  a  trocar 
was  deemed  useless,  and  an  exploratory  inci- 
sion was  consequently  decided  upon.  For  this 
the  point  of  selection  was  to  the  left  of  the 
umbilicus,  where  a  perpendicular  opening  two 
inches  in  length  was  made.  The  tumor  was 
then  punctured,  but  only  a  little  dark  fluid 
escaped  from  it.  The  incision  was  now  ex- 
tended to  a  size  sufficient  to  admit  the  hand 
into  the  tumor  for  the  breaking  up  and  removal 
of  its  contents  as  far  as  possible.  At  this  stage 
of  the  operation  (and  this  is  an  important  point, 
showing  the  lack  of  appreciation  of  McDowell's 
long  incision)  a  pair  of  forceps  was  introduced, 
and  the  posterior  wall  of  the  cyst  (said  to  be 
an  inch  in  thickness)  was  seized  and  drawn  out, 
when  a  piece  of  it  "the  size  of  a  man's  hand" 
was  cut  off.  With  all  this  breaking  up  and 
excision  of  the  cyst  walls,  the  tumor  still  could 
not  be   drawn   through    the  original    opening. 


IN  GERMANY.  373 

Now  it  was  thought  advisable  to  extend  the 
incision  to  seven  or  eight  inches  (McDowell's 
long  incision),  when,  to  the  astonishment  of  all, 
the  tumor,  which  had  a  pedicle,  of  the  size  of 
the  little  finger,  at  once  became  movable  and 
could  be  lifted  out  of  the  abdomen.  Next,  a 
ligature  was  made  to  encircle  the  pedicle  in 
mass  ;  but  the  operator,  noting  the  large  size  of 
the  divided  arteries,  afterward  decided  to  re- 
move the  first  ligature  put  on  and  to  tie  each 
artery  separately.  To  this  mode  of  individu- 
ally tying  the  arteries  he  attached  great  value, 
and  claimed  originality  for  it.  The  case  termi- 
nated fatally  at  the  end  of  sixty  hours. 

Now,  considering  the  character  of  this  tumor, 
its  size  (forty-six  and  a  half  pounds),  the  time 
taken  up  in  the  mutilation  of  its  walls,  and  the 
delay  in  changing  the  ligatures,  can  anyone  say 
that  the  long  incision  of  McDowell,  made  at  the 
outset,  would  not  have  been  the  proper  thing 
to  do  ?  Or,  that  the  chances  of  saving  the  life 
of  the  patient  would  not  thereby  have  been 
greatly  increased  ? 

Dr.  Dolhoff,  in  his  second  case,  made  a 
medium  incision,  but,  finding  this  insufficient, 
he  at  once  extended  it  into  the  upper  division 
of  the  abdomen,  making  it  accord  fully  with  Mc- 


274  MCDOWELL'S  OPERATLON 

Dowell's  teachings.  The  removal  of  the  tumor, 
however,  could  not  be  effected,  and  the  case 
terminated  fatally  at  the  end  of  eight  hours. 

Dr.  Dolhoff,  in  his  remarks  upon  the  case  of 
false  diagnosis  and  the  result  of  his  operation, 
endeavored  to  explain  the  mistake  as  being 
mainly  due  to  a  spasmodic  contraction  of 
the  abdominal  muscles.  He  further  remarks, 
strange  as  it  may  seem,  that  the  patient  was 
relieved  in  a  great  degree  of  all  her  old  symp- 
toms, and  remained  so  until  the  following  April 
(1837),  when  they  returned  and  became  as 
troublesome  as  ever.  After  a  long  and  inef- 
fectual trial  of  a  seton  in  the  abdominal  wall, 
she  was  discharged  unrelieved. 

Regarding  the  cystitis  described  in  this  case, 
whether  or  not  it  existed  as  cause  or  effect  of 
the  hysteria  present,  there  was  certainly  a 
direct  relationship  between  the  two  ;  and  this 
goes  far  to  explain  the  cause  of  the  error  in 
diagnosis,  and,  consequently  the  uselessness 
of  the  operation  that  was  performed. 

Dr.  Dolhoff,  in  premising  his  report  of  this 
case,  properly  and  justly  remarks,  that  it  is  the 
duty  of  every  surgeon  to  publish  his  mistakes 
as  well  as  his  triumphs,  referring  at  the  same 
time  to  the    unfortunate  operation    performed 


IN  GERMANY.  375 

under  like  circumstances  by  an  eminent  British 
surgeon. 

In  such  a  diseased  state  of  the  bladder  as 
found  in  Dr.  Dolhoff's  case,  ureteritis  or  pye- 
litis, on  one  or  both  sides,  was  to  be  expected 
as  a  direct  sequence,  and  the  symptoms  charac- 
terizing either  one  of  these  affections  are  just 
such  as  would  lead  a  patient  suffering  from 
them  for  a  long  time  to  imagine  that  she  might 
have  a  tumor  in  her  abdomen,  as  he  describes. 

As  showing  the  wide  range  of  bodily  and 
mental  sufferings  (real  and  imaginary)  closely 
related  to  some  of  the  diseases  of  the  genito- 
urinary organs,  the  writer  has  grouped  the 
symptoms  occurring  in  cases  of  this  class 
according  to  the  relation  which  cystitis  bears  to 
ureteritis  and  renal  tenesmus,  a  relationship 
which  he  pointed  out  in  a  recent  paper  on  the 
subject.1  He  has  now  the  records  of  two-cases 
in  each  of  which  incurable  disease  was  declared 
to  exist  in  both  ovaries,  by  two  eminent  sur- 
geons, and  they  were  respectively  laparoto- 
mized  successfully  without  the  slightest  benefit. 

1  Renal  Tenesmus  :  A  Result  of  Chronic  Cystitis  and  Ureter- 
itis ;  Successful  Treatment  by  Kolpo-uretero-cystotomy  and 
Intravaginal  Drainage,  combined  with  Elevation  and  Support 
of  the  Uterus  and  Ovaries.  The  Medical  Record,  August  4, 
1888. 


-,76  MCDOWELL'S  OPERATION 

Afterward,  by  means  of  kolpo-uretero-cys- 
totomy,  the  writer  diagnosticated  in  one  case 
grave  disease  in  both  kidneys,  as  shown  by  the 
purulent  discharge  present,  and  in  the  other 
cystitis  with  ureteritis  and  renal  tenesmus  of 
the  left  side.  Both  the  cases  terminated 
fatally,  and  in  one  the  autopsy  revealed  pyelitis 
calculosa  in  both  kidneys.  In  the  other  case 
there  occurred  melancholia  and  refusal  to  eat, 
which  terminated  in  insanity  with  hallucinations 
of  a  state  of  pregnancy  and  impending  parturi- 
tion, and  finally  in  death  from  starvation.  The 
melancholia  resulted  directly  from  the  realiza- 
tion of  her  unnecessary  mutilation  in  the 
sacrifice  of  her  ovaries,  of  which  she  herself 
became  convinced  after  she  had  been  relieved 
of  her  vesical,  ureteral,  and  renal  complications 
by  the  kolpo-uretero-cystotomy  and  the  subse- 
quent intravaginal  drainage. 

Such  is  the  writer's  view  and  explanation  of 
the  complications  presented  in  Dr.  Dolhoff's 
case,  and  of  the  circumstances  that  led  him  into 
the  mistake  of  performing  the  unjustified  oper- 
ation he  describes,  which  arose,  not  from  an 
error  of  judgment  at  the  period  of  its  perform- 
ance (as  should  here  be  noted  to  his  credit), 
but,  from  a  want  of  appreciation    in    surgical 


IN  GREAT  BRITAIN.  ^yy 

science  at  that  date  of  the  true  relationship 
between  the  diseases  of  the  uterus  and  its 
appendages,  on  the  one  hand,  and  the  diseases 
of  the  bladder,  ureters,  and  kidneys  on  the 
other,  such  as  has  just  been  pointed  out. 


SECTION    IV. 

Great  Britain. 

The  operation  of  tapping  for  the  relief  and 
cure  of  general  dropsy,  as  a  cause  of  impair- 
ment of  health  and  obstruction  of  respiration 
and  other  important  functions  of  the  body,  dates 
back,  there  is  reason  to  believe,  to  the  time  of 
the  Greeks  and  Romans.  From  the  long-ac- 
cepted knowledge  of  the  value  of  tapping  for 
meeting  the  indications  mentioned  there  is,  also, 
reason  to  believe  that  encysted  dropsy  resulting 
from  whatsoever  cause,  and  in  reeard  to  the 
distinctive  character  of  which  no  settled  theory 
was  held,  was  treated  until  within  two  or  three 
centuries  of  our  own  time  in  the  same  way,  and 
even  cured,  under  favorable  influences,  now  and 
then.  But  the  precise  period  in  the  history  of 
medicine  at  which  the  latter  affection  came  to 


378  MCDOWELL'S  OPERATLON 

be  specially  studied  and  differentiated  from 
general  dropsy,  and  treated  with  an  appreciation 
of  its  distinctive  pathology,  cannot  now  be  satis- 
factorily determined.  From  all  that  I  have  been 
able  to  learn  from  my  present  investigation  of 
the  subject  it  is  evident  that  this  knowledge 
could  not  have  existed  long,  if  at  all,  prior  to 
the  beginning  of  the  last  century.  There  is 
reason  to  believe,  however,  that,  independently 
of  there  not  being  any  settled  views  among 
writers  in  regard  to  the  differences  between 
general  and  encysted  dropsy,  the  operation  of 
tapping  in  both  affections,  previously  to  the 
period  named,  had  been  more  or  less  extended 
and  improved  by  enlarging  the  trocar  puncture 
by  incision,  for  the  better  escape  of  the  varying 
fluids  and  the  easier  introduction  of  a  tent  for 
drainage,  the  latter  being  used  either  alone  or 
in  conjunction  (especially  in  the  encysted  va- 
riety) with  injections.  Whether  or  not  this 
conclusion  be  correct  with  regard  to  the  con- 
joined use  of  the  knife,  prior  to  the  early  date 
of  which  I  am  speaking,  the  case  of  Dr.  Robert 
Houston,  of  Glasgow,  Scotland,  establishes  the 
fact,  beyond  any  question,  that  in  1701  he  not 
only  recognized  the  distinct  form  of  encysted 
dropsy  as  differing  essentially  from  that  of  gen- 


IN  GREA  T  BRITAIN.  379 

eral  dropsy,  but  suggested  and  executed  an 
original  procedure  of  incision,  with  draijiage  by 
tent  in  the  lower  divisioji  of  the  abdomen,  curing 
his  patient  by  the  plan  in  the  course  of  three  or 
four  weeks.  In  order  to  render  this  practice 
more  distinctive  I  have  termed  it  incisionism, 
and  the  surgeons  who  employed  it  incisionisls. 
This  operation  of  Houston,  so  far  as  we  know, 
inaugurated  the  practice  of  incision  indepen- 
dently of  tapping.  I  have  previously  referred 
to  Houston's  case  in  connection  with  several 
points  in  my  study  of  encysted  dropsy,  and 
showed  the  influence  of  his  method  of  incision- 
ism with  drainage  upon  the  practice  of  after 
years,  especially  in  France,  where  the  method 
was  employed  and  enlarged  upon  by  Le  Dran, 
Delaporte,  Theden,  and  L'Aumonier,  up  to  the 
time  that  McDowell  associated  with  it  the  ex- 
tirpation of  the  ovary  by  his  long  incision, 
embracing  both  the  lower  and  upper  divisions 
of  the  abdomen. 

From  the  importance  of  Houston's  practice, 
and  the  credit  due  him  for  the  advance  he  made 
upon  the  old  operation  of  tapping,  it  is  proper 
that  the  report  of  his  case,  with  the  description 
of  his  procedure  and  the  result,  should  here  be 
copied  in  full,  this  case  marking  the  beginning 


-,g0  MCDOWELL'S  OPERATION 

of  the  treatment  of  a  dropsical  ovary  by  simply 
the  short  incision  with  drainage,  without  at- 
tempting removal  of  the  diseased  organ  (1701), 
and  by  the  long  incision  with  extirpation  of  the 
diseased  organ  (1809.) 

I  may,  perhaps,  be  excused  for  trespassing 
upon  the  time  of  the  reader  for  this  purpose,  on 
the  ground  that  the  old  and  rare  work  in  which 
this  case  is  recorded  is  not  readily  accessible  for 
reference  except  to  a  few  physicians.  In  addi- 
tion to  this,  certain  unwarranted  comments, 
affecting  the  claims  of  McDowell,  that  have  been 
made  upon  the  case  by  various  authors,  demand 
attention,  and  they  can  be  better  and  more  fairly 
made  with  all  the  facts  relating  to  the  case  pre- 
sented in  the  author's  own  words.  For  exam- 
ple, John  Gorham,  Esq.,  of  England,  in  his 
efforts  to  give  importance  to  the  Hunterian 
short  incision,  couples  the  history  in  part  of 
this  case  with  the  cases  of  Dr.  Nathan  Smith, 
and  Messrs.  Jeaffreson,  King,  and  West,  in 
order  to  show  that  they  were  the  first  to  com- 
prehend the  true  principles  of  the  operation  of 
extirpation  of  the  ovary,  forgetting  that  extirpa- 
tion of  the  organ,  with  extension  of  the  practice 
of  incisionism  so  as  to  include  both  the  lower 
and  upper  divisions  of  the  abdomen,  were  the 


IN  GREA  T  BRITAIN.  3  8 1 

essential  features  of  the  operation,  and  that  to 
McDowell  alone  belonged  the  credit  for  these 
innovations. 

The  late  Dr.  W.  L.  Atlee,  in  the  United 
States  (1845),  published  his  first  "Table  of  Sta- 
tistics upon  Ovariotomy,  "without  knowing  about 
Houston's  case,  and  introduced  only  the  names 
of  L'Aumonier,  Dzondi,  and  Galenzowski,  as 
preceding  that  of  McDowell  in  point  of  priority. 
Discovering,  however,  from  the  London  Philo- 
sophical Transactions,  some  four  years  later, 
his  error  in  having  omitted  to  place  Houston's 
name  in  the  list  of  previous  operators,  he  ad- 
dressed a  note  to  the  late  Dr.  Isaac  Hays, 
editor  of  the  American  yournal  of  the  Medical 
Sciences,  which  was  headed  as  follows  :  "  Ova- 
rian Dropsy  by  the  Long  Abdominal  Incision  in 
1 701,  by  Robert  Houston."1  Accompanying  it 
with  a  full  copy  of  the  report  of  the  case,  in 
quotation  marks,  under  Houston's  heading:  "A 
Dropsy  in  the  Left  Ovary  of  a  Woman,  aged 
fifty-eight  years,  Cured  by  a  Large  Incision, 
Made  in  the  Left  Side  of  the  Abdomen."  In 
his  corrected  and  enlarged  table  of  cases  of 
ovariotomy,  published  two  years  later,2  he  adds 

1  Op.  cit.,  1849,  v°l-  xvii-»  P-  534. 

2  Trans,  of  the  Am.  Med.  Association,  1851. 


382 


MC D O  WELL'S  OPERA  TION 


Houston's  name  to  the  other  three  given,  thus 
making  the  number  of  surgeons  four  who  had 
preceded  McDowell  in  the  operation  of  ovari- 
otomy. His  reprint  of  this  publication  bears 
the  title:  "A  Table  of  All  the  Known  Opera- 
tions of  Ovariotomy,  from  1701  to  185 1,  Com- 
prising Two  Hundred  and  Twenty- two  Cases, 
Including  their  Synoptical  History  and  Ana- 
lysis." 

•  Still  again,  Professor  Mapother,  in  an  intro- 
ductory address  on  "Dublin  Medical  Schools," 
speaks  at  length  of  the  "  School  of  Surgery." 
In  a  published  abstract  of  this  address1  I  have 
found  enumerated  a  great  number  of  names  of 
distinguished  men  connected  with  the  history 
of  this  school,  commencing  with  those  of  Mullen, 
the  anatomist  of  the  seventeenth  century,  and 
Proby,  the  first  surgeon-general,  and  ending 
with  those  of  Mr.  Cusack,  Professor  Maccart- 
ney,  Dr.  Shekleton,  and  Dr.  Houston.  The 
writer,  in  concluding  his  notice  of  the  last- 
named  and  his  great  work,  the  Catalogue  of  the 
Museum,  says  :  „ 

"Toa  namesake  of  Houston,  and  to  a  namesake  of  his 
contemporary,  Ephraim  McDowell,  is  assigned  the  first 
performance  of  ovariotomy.     Professor  Gross,  in  a  memoir 

1  British  Medical  Journal,  1873,  vol.  ii.,  p.  634. 


IN  GKEA  T  BRITAIN. 


3S3 


of  the  great  Kentuckian  of  the  latter  name,  asserts  that  in 
1809  he  performed  ovariotomy  for  the  first  time;  but  Dr. 
Mapother  found,  by  the  thirty-third  volume  of  the  Philo- 
sophical Trans actiojis,  that  it  was  done  successfully  by  a 
Dr.  Houston  in  1701." 

So  much,  then,  for  the  injustice  done  Mc- 
Dowell's claim  of  originality  in  the  first  extirpa- 
tion of  the  ovary,  and  for  the  absurdity  of  any 
other  claim  for  Houston  than  the  important, 
and  certainly  the  very  creditable',  one .  for  his 
time  of  accomplishing  the  cure  of  his  case  by 
incisionism  with  drainage  in  the  lower  division 
of  the  abdomen.  This  had  nothing  whatever 
to  do  with  extirpation  of  the  ovary  by  the  long 
incision  made  in  both  the  lower  and  upper 
divisions  of  the  abdomen,  the  achievement  ac- 
complished by  McDowell  a  little  over  one 
hundred  and  eight  years  later. 

With  these  necessary  preliminary  statements 

I   now  introduce  the   report  of  Dr.  Houston's 

case1  as  published  by  him  : 

"A  Dropsy  in  the  Left  Ovary  Cured,"  by  Dr.  R.  Hous- 
toun.  In  August,  1 701,  I  was  desired  to  visit  one  Margaret 
Millar,  a  poor  woman  of  58  years  of  age,  who  lived  not 
far  from  Glasgow,  and  lay  bedrid  of  an  uncommon  disease. 
She  inform' d  me  that  her  midwife  having  violently  pulled 
away  the  burthen  in  her  last  lying-in,  at  45  years  old,  she 

1  The  Philosophical  Transactions,  N.  381,  Jan.,  etc.,  1724, 
*  p.  8.     (From  the  year  1720  to  the  year  1732).     Abridged  and 
Disposed  under  General  Heads,  vol.  vi.,  Part  ii.,  hi.,  iv. 


3^4 


MC D O  WELL'S  OPERA  TION 


was  very  sensibly  affected  by  a  pain  which  then  seized 
her  in  the  left  side  between  the  umbilicus  and  groin,  and 
had  scarce  ever  been  free  from  it  after,  it  having  troubled 
her  more  or  less  during  13  years  together;  that  for  two 
years  past  she  had  been  extremely  uneasy,  her  belly  grew 
very  large,  and  a  difficulty  of  breathing  increased  con- 
tinually upon  her ;  insomuch  that  for  the  last  six  months 
she  could  scarce  breathe  at  all  without  the  utmost  diffi- 
culty. That  in  all  that  space  of  time  she  had  scarce  eat 
so  much  as  would  nourish  a  suckling  child,  having  quite 
lost  her  appetite,  and  that  for  the  three  last  months  she 
had  been  forc'd  to  lie  constantly  on  her  back,  not 
daring  to  move  at  all  to  one  side  or  other.  This  tumour 
drew  towards  a  point,  and  was  grown  to  so  monstrous 
a  bulk  that  it  engross' d  the  whole  left  side  from  the 
umbilicus  to  the  pubes,  and  stretch' d  the  abdominal 
muscles  to  so  unequal  a  degree  that  I  never  saw  the  like. 
Her  lying  so  continually  on  her  back  having  greviously 
excoriated  her,  added  much  to  her  sufferings,  which,  with 
want  of  rest  and  appetite,  had  wasted  her  to  skin  and 
bone.  I  told  her  that  in  order  effectually  to  relieve  her, 
and  remove  the  cause  of  the  swelling,  I  must  lay  open  a 
great  part  of  her  belly,  but  feared  she  would  not  be  able  to 
undergo  such  an  operation  :  she  seemed  not  at  all  fright- 
ened, but  heard  me  without  disorder,  and,  though  scarce 
able  to  speak,  urg'd  me  to  perform  it.  I  must  confess  I 
drew  almost  all  my  confidence  from  her  unexpected  resolu- 
tion, and  without  loss  of  time  prepared  what  the  place 
would  allow,  and  with  an  imposthume  lancet  laid  open 
about  an  inch ;  but  finding  nothing  issue  I  enlarged  it  two 
inches,  and  even  then  nothing  came  forth  but  a  little  thin 
yellowish  serum ;  so  I  ventured  to  lay  it  open  about  two 
inches  more ;  I  was  not  a  little  startled  to  find  only  a 
glutinous  substance  stop  up  so  large  an  aperture;  but  my 
great  difficulty  was  to  remove  it;  I  tri'd  my  probe,  I  en- 
deavoured to  do  it  with  my  finger,  but  all  in  vain ;  it  was 
so  slippery  that  it  eluded  every  touch  and   the  strongest 


IN  GREA  T  BRITAIN. 


385 


hold  I  could  take.  I  wanted,  in  this  place,  almost  every- 
thing necessary,  but  bethought  myself  of  a  very  odd  instru- 
ment, yet  as  good  as  the  best,  because  it  answered  the  end. 
I  took  a  strong  fir  splinter,  and  having  wrapt  some  lint 
about  the  end  of  it,  I  thrust  it  into  the  wound,  and  by 
turning  and  winding  it  drew  out  above  two  yards  length  of 
a  substance  thicker  than  any  gelly,  or  rather  like  glue  that's 
fresh  made  and  hung  out  to  dry ;  the  breadth  of  it  was 
about  ten  inches ;  this  was  followed  by  nine  full  quarts  of 
such  matter  as  I  have  met  with  in  steatomatous  and  ather- 
omatous tumours,  with  several  hydatides  of  various  sizes 
containing  a  yellowish  serum,  the  least  of  them  bigger  than 
an  orange,  with  several  large  pieces  of  membranes  which 
seemed  to  be  parts  of  the  distended  ovary.  Having 
squeezed  out  all  I  could,  I  stitched  up  the  wound  in  three 
places  almost  equidistant;  and,  having  no  other  but 
Lucatellus's  balsam,  with  it  I  covered  a  pledget  the  whole 
length  of  the  wound,  and  over  that  laid  several  compresses 
dipt  in  warm  French  brandy ;  and  because  I  judged 
that  the  parts  might  have  lost  their  spring  by  so  vast  and 
so  long  a  distention,  I  dipt  in  the  same  brandy  a  large 
napkin  four  times  folded  and  applied  it  over  all  the  dress- 
ings, and  with  a  couple  of  strong  towels,  which  were  also 
dipt,  I  swathed  her  round  the  body,  and  then  gave  her 
about  four  ounces  of  this  mixture  : 

R. — Aq.  menthse lb.ss. 

Aq.  cinnamomi  fort     ....     lb.iss. 
Syr.  diacodii ,§vi. — M. 

— ordering  her  also  to  take  two  or  three  spoonfuls  of  it 
four  times  a  day.  The  cinamon  water  was  drawn  off  from 
canary  and  the  best  cinnamon.  Next  morning  I  found 
her  in  a  bathing  sweat,  and  she  informed  me  with  great 
joy  that  she  had  not  slept  so  much  nor  found  herself  so 
well  refreshed  at  any  time  for  three  months  past.  I  care- 
fully dressed  her  wOund  in  the  same  manner  as  above  once 
a  day  for  about  a  week ;  I  kept  in  the  lower  part  of  the 

25 


386 


MCDO  WELL'S  OPERA  TION 


wound  a  small  tent,  which  discharged  some  serosities  at 
every  dressing  for  four  or  five  days.  But,  business  calling 
me  elsewhere,  I  instructed  her  daughters  how  to  dress  the 
wound,  and  told  them  what  diet  I  thought  most  proper, 
which  was  chiefly  strong  broth  made  of  an  old  cock,  in 
each  porringer  whereof  was  one  spoonful  of  cinnamon 
water ;  this  she  repeated  four  times  a  day,  and  it  gave  her 
new  life  and  spirits.  After  three  weeks'  absence  I  called 
at  her  house,  and  finding  it  shut  up  was  a  little  surprised, 
but  had  not  gone  far  before  I  was  much  more  so,  for  I 
found  her  sitting  wrapt  up  in  blankets  and  giving  direc- 
tions to  some  labourers  who  were  cutting  down  her  corn. 
She  mended  apace,  and  lived  in  perfect  health  from  that 
time  till  October,  1714,  when  she  died  after  ten  days' 
sickness." 

Having  now  shown  the  early  labors  of  Dr. 
Houston  by  incisionism  with  drainage  in  the 
lower  division  of  the  abdomen,  we  are  pre- 
pared better  to  appreciate  the  influence  it  had 
upon  the  profession,  especially  in  France.  Here, 
some  thirty  years  later,  it  was  taken  up,  as  we 
have  seen,  by  Le  Dran  (1736-46)  and  greatly 
improved  upon  by  both  him  and  Delaporte, 
the  latter  in  1753  making  the  first  suggestion 
"to  remove  the  focus  of  the  disease,  namely, 
the  tumor  formed  by  the  ovary."  Soon  after 
Delaporte's  important  suggestion  of  the  prefer- 
ableness  of  removing  "  the  focus  of  the  dis- 
ease" to  that  of  simple  incisionism  in  the  lower 
division  of  the  abdomen,  Theden  recommended 
a  scheme  of  making  a  small  incision  in  the  in- 


IN  GREA  T  BRITAIN.  387 

guinal  region,  somewhat  as  Le  Dran  had  done 
in  his  first  case,  based  upon  the  theory  that  the 
diseased  ovary  was  always  to  be  found  outside 
of  the  peritoneum,  in  which  situation  it  could  be 
exposed,  punctured,  drawn  out,  and  ligated, 
and  thus  be  strangulated  or  amputated,  as  cir- 
cumstances called  for.  Theden  proposed  this 
procedure,  as  indicated,  purely  upon  theoretical 
grounds,  and  there  is  no  evidence  to  show  that 
any  one  ever  put  it  into  practice,  though  it  was 
highly  commended  by  Morand,  and  somewhat 
enthusiastically  endorsed  at  the  time  by  Drs, 
Power  and  Darwin,  in  England.  These  points 
have  been  fully  brought  out  in  the  French  his- 
tory of  the  subject,  and  do  not  here  call  for 
further  comment. 

With  regard  to  the  influence  that  Theden's 
theory  of  an  operation  for  the  removal  of  a 
dropsical  ovary  had  upon  the  practice  of  Great 
Britain,  at  the  period  of  which  we  are  speaking, 
I  am  without  the  necessary  data  to  speak  posi- 
tively. 

Dr.  William  Hunter,  in  England,  about  the 
same  period  that  Theden,  in  France,  is  credited 
with  his  proposal,  called  into  question  the  views 
then  entertained  regarding  the  scirrhous  oriein 
of  the  dropsical  ovaries,  mainly  brought  out  in 


388  MCDOWELL'S  OPERATLON 

the  latter  country,  claiming  that  many  little 
bags,  or  cysts,  found  one  within  another  on  the 
inside  of  a  "dropsical  ovarium"  were  not  scir- 
rhous." He  thus  took  the  lead  in  advocating  a 
more-advanced  step  regarding  the  pathology  of 
the  disease,  and  the  basis  of  his  views  is  found 
in  a  communication  entitled  "The  History  of 
an  Emphysema,"  *  by  William  Hunter,  M.D., 
read  October  31,  1757,  before  a  Society  of 
physicians  in  London.  Under  this  title  he  dis- 
cusses, in  addition  to  emphysema,  "the  cellular 
membrane  and  some  of  its  diseases,"  together 
with  general  and  encysted  dropsy  of  the  ovarium, 
with  attending  anasarca.  He  states  that  he 
had  seen  a  great  many  cases  of  "  encysted 
dropsy  of  the  ovarium,"  both  in  the  living  and 
in  the  dead,  and  that  he  had  never  seen  one  in 
which  there  was  a  perceptible  diminution  of  the 
enlargement  by  any  other  plan  of  treatment 
than  by  the  trocar.  He  thought  that  the  ana- 
sarca of  the  lower  extremities  attending  this 
disease  was  less  amenable  to  relief  by  incisions 
than  the  same  result  attending  general  dropsy. 
He  further  held  that  encysted  dropsy  of  the 
ovarium  was  incurable,  remarking  that  "a 
patient  will    have    the   best   chance  of    living 

1  Med.  Observations  and  Inquiries,  London,  1762,  vol.  ii.,  p.  41. 


IN  GREA  T  BRITAIN. 


389 


longest  under  it  who  does  the  least  to  get  rid 
of  it."  Surgeons  of  the  highest  reputation,  he 
adds,  had  proposed  and  advocated  "a  radical 
cure  by  incision  and  suppuration  (incisionism), 
or  by  excision  of  the  cyst,"  but  the  former  prac- 
tice could  only  be  pursued  under  particular  cir- 
cumstances, and  the  latter  hardly  admitted  of 
an  attempt. 

Dr.  Hunter's  views  with  regard  to  the  origin, 
growth,  and  complications  of  the  disease,  and 
his  proposed  plan  of  "excision  of  the  cyst," 
which  he  thought  might  be  employed  under 
extreme  circumstances,  together  with  his  ob- 
jections to  the  procedure  by  incisionism,  are 
concisely  stated  in  the  following  quotation  : 

"I  can  hardly  say  that  I  have  ever  found  any  part  of  a 
dropsical  ovarium  in  a  truly  scirrhous  state.  What  at  first 
view  might  seem  such  proved,  upon  cutting,  to  be  a  com- 
pact group  of  small  bags,  or  a  spongy  substance  filled  with 
gelly. 

"Generally,  before  the  patient  dies  of  such  a  dropsy, 
some  degree,  both  of  leucophlegmatia  and  of  ascites,  is 
brought  on,  so  that  when  such  bodies  are  opened  some 
water  is  found  loose  in  the  cavity  of  the  belly,  and  some- 
times the  cyst  is  found  to  have  burst,  and  to  have  dis- 
charged its  contents  into  that  cavity. 

"  Now,  if  the  disease  be  nearly  what  I  have  stated,  must 
not  the  wound  made  in  the  belly  for  the  excision  of  the 
cyst  or  cysts  always  be  large  enough  to  admit  the  surgeon's 
whole  hand  ?  Must  it  not  be  often  a  good  deal  larger,  as 
when  the  tumor  is  large,  and  composed  of  a  number  of 


39° 


MCDOWELL'S  OPERATION 


bags  filled  with  gelly?  Would  not  such  a  wound  be 
attended  with  a  good  deal  of  danger  from  itself?  Would 
it  not  be  very  difficult  to  cut  the  peduncle,  or  root  of  the 
tumor,  with  one  hand  only  introduced  ?  Would  it  not  be 
impossible  to  do  this,  where  the  adhesions  proved  to  be 
considerable?  Would  there  not  be  great  danger  of  wound- 
ing the  intestines?  If  any  considerable  branch  of  the 
spermatic  artery  should  be  opened,  what  could  the  surgeon 
do  to  stop  the  bleeding?  If  it  be  proposed,  indeed,  to 
make  such  a  wound  in  the  belly  as  will  admit  only  two 
fingers,  or  so,  and  then  tap  the  bag,  and  draw  it  out,  so  as 
to  bring  its  root  or  peduncle  close  to  the  wound  of  the 
belly,  that  the  surgeon  may  cut  it  without  introducing  his 
hand,  surely  in  a  case  otherwise  so  desperate  it  might  be 
advisable  to  do  it,  could  we  beforehand  know  that  the  cir- 
cumstances would  admit  of  such  treatment. 

"With  regard  to  incision  and  suppuration,  all  that  is 
proposed  to  be  got  by  this  painful  operation  is  the  change 
of  the  dropsy  into  an  incurable  fistula  in  the  belly.  For 
this  the  patient  must  not  only  undergo  much  pain,  but 
likewise  be  exposed  to  great  danger,  particularly  where  the 
cyst  happens  not  to  adhere  to  the  muscles  at  the  part  where 
the  incision  is  made,  or  where  there  are  a  number  of  cysts. 
In  the  first  case,  the  wound  will  be  a  large  one,  communi- 
cating with  the  cavity  of  the  abdomen,  and  both  the  exter- 
nal air  and  the  contents  of  the  incised  cyst,  will  be  admitted 
into  that  cavity,  so  that  we  may  expect  very  considerable 
inflammation.  In  the  second  case,  where  there  are  a  num- 
ber of  cysts,  the  inflammation  and  suppuration  will  either 
be  too  slight  to  discharge  all  of  them,  or  too  considerable 
to  be  supported  with  life." 

From  this  presentation  of  Dr.  Hunter's  views 
on  the  pathology  of  ovarian  dropsy,  together 
with  his  theoretical  operation  for  the  removal 
of  this  disease,  it  must  be  confessed  that  credit 


IN  GREA  T  BRITAIN.  39 1 

is  due  him  for  having  attained  a  clearer  insight 
into  the  nature  of  the  disease  and  a  more  prac- 
tical comprehension  of  what  sort  of  a  procedure 
was  called  for  for  its  removal  than  any  one  who 
had  ever  written  upon  the  subject  before.  It 
was  virtually  an  intelligent  and  practical  re- 
sponse to  the  timid  suggestion  of  Delaporte  in 
France,  after  his  disastrous  failure  by  the  old 
method  of  incisionism  a  few  years  previously, 
"  to  remove  the  focus  of  the  disease — namely, 
the  tumor  formed  by  the  ovary."  With  strong 
common  sense  he  suggests  that  the  opening  in 
the  abdomen  should  at  least  be  large  enough 
to  admit  the  surgeon's  hand  for  the  required 
manipulations  of  the  tumor,  and  that  even  an 
opening  of  this  size  might  not  prove  sufficient 
when  adhesions  and  complications  with  neigh- 
boring viscera  existed,  with  the  danger  of  hem- 
orrhage that,  was  liable  to  attend  any  effort  to 
overcome  such  obstacles.  In  regard  to  a  small 
opening  by  a  short  incision  he  had  also  a  clear 
conception  of  just  what  was  barely  necessary 
to  enable  the  surgeon  under  favorable  circum- 
stances  to  expose  the  cyst,  tap  it,  draw  it  out, 
and  excise  "its  root  or  peduncle  close  to  the 
wound  of  the  belly."  Whether  or  not  he 
thought  constriction  of  the  pedicle  before  exci- 


oq2  MCDOWELL'S  OPERATION 

sion  necessary  he  does  not  state,  but  that  he 
did  may  be  inferred  from  his  mention  of  the 
danger  of  wounding  the  spermatic  artery  in  the 
operation. 

In  his  proposal  of  a  short  incision  is  seen  the 
influence  exerted  upon  him  by  the  previous 
teachings  of  the  incisionists,  requiring  the  open- 
ing to  be  made  in  the  lower  division  of  the 
abdomen,  as  limited  by  a  transverse  line  at  the 
umbilicus  ;  but  the  exact  mode  he  describes  of 
making  the  incision  of  a  certain  length,  admit- 
ting "two  fingers  or  so,"  is  unquestionably 
original.  There  is  nothing  in  the  history  of  the 
subject  to  the  date  of  McDowell's  operation 
that  approaches  his  proposed  method  for  clear- 
ness of  conception  as  to  the  kind  of  an  opening 
in  the  abdomen  necessary  for  the  removal  of  a 
dropsical  ovary  composed  of  one,  two,  or  three 
cysts.  Appreciating  the  principle,  as  we  do 
now,  we  cannot  fail  to  wonder  why  there  was 
no  surgeon  in  Great  Britain  to  profit  by  Hun- 
ter's teachings  until  after  McDowell  had  led 
the  way  fifty-two  years  later,  combining  with 
a  long  incision  the  all-important  step  of  extir- 
pation of  the  ovary.  Whether  McDowell  was 
familiar  with  his  theory  of  an  operation  for  ex- 
tirpation of  the  ovary  there  is  nothing  to  show, 


IN  GREAT  BRITAIN.  393 

further  than  the  fact  that  he  was  a  medical  stu- 
dent in  the  University  of  Edinburgh  during  the 
session  of  1793-94,  and  while  there  listened  to 
the  lectures  of  Mr.  John  Bell,  one  of  the  most 
eminent  surgeons  of  that  day.  But  whether  or 
not  while  there  he  learned  anything  definite 
regarding  the  theoretical  views  of  either  Theden 
or  Hunter  (and  this  is  certainly  a  matter  of 
great  doubt,  to  say  the  least),  is  of  no  prac- 
tical importance,  since  it  was  thirteen  years 
after  his  return  to  the  United  States  that  he 
encountered  in  the  backwoods  of  Kentucky, 
where  he  was  thrown  entirely  upon  his  own 
resources,  his  first  case  of  dropsical  ovary.  Un- 
der these  circumstances,  what  mode  of  proce- 
dure do  we  find  him  following  ?  Was  it  by  the 
old  method  of  making  a  small  opening  in  the 
lower  division  of  the  abdomen  as  formerly  em- 
ployed by  the  old  incisionists,  notably  by  Hous- 
ton, Le  Dran,  and  Delaporte,  and  as  extended 
in  theory  by  Theden  and  Hunter  ?  No,  it  was 
by  the  long  iiicision  that  properly  bears  his 
name,  made  (though  outside  of  the  rectus  mus- 
cle) in  both  the  lower  and  the  upper  divisions 
of  the  abdomen,  from  the  margin  of  the  ribs  to 
the  os  pubis  ;  thus  affording  opportunity  for 
the  fullest  exposure  of  the  tumor,  the  widest 


394  MCDOWELL'S  OPERATION 

possible  range  for  the  manipulation  of  the  same, 
the  discovery  of  complications,  and  the  preven- 
tion of  accidents. 

Dr.  Nathan  Smith,  who,  as  we  have  seen, 
was  the  first  surgeon  in  the  United  States  to 
imitate  McDowell  in  the  extirpation  of  a  drop- 
sical ovary  (July  5,  1821),  in  his  case  followed 
almost  precisely  the  theory  of  Dr.  Hunter  in 
puncturing  and  drawing  out  the  collapsed  cyst 
through  a  short  incision.  In  fact  the  whole 
procedure  was  carried  out  by  him  on  the  theory 
of  the  cyst  being  small  and  simple,  and  on  the 
line  of  old  incisionism  In  the  lower  division  of 
the  abdomen,  but  combined  with  the  practical 
and  essential  features  of  extirpation  of  the 
ovary  by  the  long  incision,  as  previously  taught 
by  McDowell,  the  account  of  which  original 
practice  had  then  been  published  over  five 
years,  and  was  familiar  to  the  profession  at 
home  and  abroad. 

As  the  facts  stand  in  medical  history,  Dr. 
Smith  published  his  case,  the  year  after  the 
operation,1  without  mentioning  McDowell's 
name  or  alluding  to  his  operation  in  the 
slightest  way.  The  result  was  that  for  a  long 
time  his  publication,  either  by  itself  or  in  con- 

1  Op.  cit. 


IN  GREAT  BRITAIN.  395 

junction  with  those  of  Mr.  John  Lizars,  of  Edin- 
burgh, was  frequently  quoted  by  writers,  who 
spoke  of  these  operators,  if  not  as  originators 
of  the  procedure,  certainly  in  such  a  way  as  to 
greatly  disparage  the  claims  of  McDowell. 

With  this  review  of  incisionism  for  the  treat- 
ment of  a  dropsical  ovary  and  the  relation  of 
the  practice  to  that  of  extirpation  of  the  dis- 
eased organ,  we  come  to  the  direct  study  of  the 
influence  of  McDowell's  completed  operation 
of  ovariotomy  by  the  long  incision  upon  British 
surgery  from  the  date  of  the  first  employment 
of  it  by  Mr.  Lizars1  to  the  time  of  its  revival  in 
England,  September,  1842,  by  Dr.  Charles 
Clay. 

Mr.  Lizars  in  his  first  communication,  which 
is  entitled  "Observations  on  Extirpation  of  the 
Ovaria,  with  Cases,"  by  John  Lizars,  F.R.S.E., 
F.R.C.S.E.,  and  Lecturer  on  Anatomy  and 
Physiology,  Edinburgh,  commences  by  quoting 
in  French  the  concluding  paragraph  of  the 
report  of  the  case  of  supposed  extirpation  of 
the  ovary  by  M.  L'Aumonier,  as  quoted  in 
the  French  history  of  the  subject,  of  which  the 
following  is  a  translation  : 

1  Edinburgh  Medical  and  Surgical  Journal,  Oct.  1824,  vol.  xxii. 
p.  247. 


39^ 


MCDOWELL'S  OPERATLON 


"  This  example  and  that  of  total  amputation  of  the 
uterus  and  vagina,  performed  with  success,  justify  the  con- 
clusion that,  with  a  thorough  knowledge  of  anatomy,  there 
are  but  few  organs  upon  which  one  may  not  perform  with 
advantage  the  different  operations  of  surgery." 

After  stating:  that  Le  Dran  and  Dzondi  had 
each  cured  dropsy  resulting  from  disease  of  the 
ovary  by  incision  and  tent  (incisionism),  the  lat- 
ter removing  the  sloughing  sac  by  the  forceps, 
he  quotes  Morand  regarding  the  removal  of  the 
healthy  ovaries  in  quadrupeds,  and  Felix  Plater 
and  Diemerbroeck,  to  show  that  the  practice  in 
women  was  not  chimerical,  as  proven  by  a  cus- 
tom among  the  Lydians  ;  Paulus  Barbette,  to 
show  he  had  opened  the  abdomen  for  disen- 
gaging a  strangulated  intestine ;  Bonetus,  as 
claiming  that  relief  was  afforded  a  lady  in 
a  similar  condition  by  the  same  operation, 
performed  by  a  military  surgeon  ;  and  Schacht, 
as  having  secured  a  similar  satisfactory  result 
by  the  same  method.  Furthermore,  to  prove 
the  practicability  and  safety  of  abdominal  sec- 
tion, he  recalls  the  well-known  practice  of  the 
Csesarean  operation,  and  refers  to  the  classic 
case  in  which  the  same  operation  was  per- 
formed six  times  successfully.     He  then  adds: 

"But  the  practicability  of  extirpating  a  diseased  ovarium 
does  not  rest  on  theory.     It  has  been  proved  by  experi- 


IN  GREA  T  BRITAIN. 


397 


ence.  L'Aumonier,  who  was  chief  surgeon  of  the  great 
hospital  at  Rouen  about  fifty  years  ago,  extirpated  the 
ovarium  successfully ;  and  since  his  time  an  ovarium  has 
been  repeatedly  removed,  and  sometimes  with  success,  par- 
ticularly in  France,  Germany,  and  America.  Dr.  Smith, 
of  Connecticut,  lately  extirpated  an  ovarium  in  a  dropsical 
state  successfully.  Three  very  instructive  cases  occurred  to 
Dr.  Macdowal,  of  Kentucky,  and  the  following  history  of 
them  was  sent,  about  seven  years  ago,  to  the  late  celebrated 
surgeon,  Mr.  John  Bell,  who  was  then  on  the  Continent, 
and  came  into  my  hands  as  having  the  charge  of  his  pa- 
tients and  professional  correspondence  during  his  absence." 

Here  follows  the  report  of  the  three  cases 
of  McDowell,  from  the  manuscript  that  had 
remained  unacknowledged  and  unpublished,  in 
his  possession,  for  seven  years,  and  he  gives  the 
narration  of  these  important  cases  entirely  with- 
out comment  or  remark,  though  making  a  few 
verbal  corrections  and  transpositions  in  the  text. 

This  brings  us  to  the  report  in  detail  of  Mr. 
Lizars's  case  of  false  diagnosis  and  unjustifiable 
operation,  in  which  the  incision  made  was  that 
of  McDowell.  He  states  that  in  the  year  182 1 
he  was  requested  by  his  friend,  Dr.  Campbell, 
to  examine  a  woman,  aged  twenty-seven,  with 
an  enlargement  of  the  abdomen  equal  to  that 
ordinarily  met  with  in  pregnancy  in  full  term. 

"  On  examination  the  tumor  occupied  the  whole  abdomi- 
nal cavity,  and  appeared  to  roll  from  side  to  side.  The 
woman  stated  that  the  enlargement  began  six  years  pre- 


393 


MCDOWELL'S  OPERATION 


viously  in  the  left  side,  and  that  she  assigned  the  cause  of 
it  '  to  several  blows  and  kicks  received  from  a  brutal  hus- 
band.' She  further  stated  that  some  two  years  after  it 
commenced  she  had  noticed  '  a  small  movable  swelling 
in  her  left  groin,  which  she  allowed  to  increase  for  twelve 
months,  when  she  came  to  Edinburgh,  and,  on  consulting 
a  surgeon,  he  opened  it  with  a  lancet,  and  discharged  a 
large  quantity  of  thin  matter.'  This  was  thought  to  be 
a  '  lumbar  abscess,'  which  she  ascribed  to  a  fall  on  her  back 
three  years  previously." 

The  patient,  after  consulting  the  "chief  medi- 
cal gentlemen"  of  Edinburgh,  many  of  whom 
pronounced  her  case  one  of  pregnancy,  and  all 
of  whom  dissuaded  her  from  an  operation, 
finally  came  to  Mr.  Lizars  for  the  removal  of 
the  supposed  tumor.     He, 

*'  convinced,  from  the  history  of  the  disease  in  the  records 
of  medicine,  and  from  gastrotomy  having  been  successfully 
performed  for  volvulus,  and  from  the  Csesarean  section, 
that  there  was  little  to  apprehend  either  from  loss  of  blood 
or  peritoneal  inflammation, ' ' 

decided  to  make  an  effort  to  relieve  her  of  her 
sufferings  by  an  operation,  choosing,  as  men- 
tioned above,  the  procedure  of  McDowell  by 
the  long  incision.  He,  accordingly,  performed 
the  operation  October  24,  1823.  This  was  six 
years  after  he  had  received  McDowell's  manu- 
script containing  the  report  of  his  first  three 
cases,  and  one  year  after  the  publication  of  the 
report  of  Dr.  Nathan  Smith's  operation. 


IN  GREAT  BRITAIN.  OQQ 

Suffice  it  to  say  that  the  diagnosis  of  Mr. 
Lizars  in  this  case  was  not  only  proved  by 
McDowell's  long  incision  to  be  wholly  false  as 
to  the  existence  of  an  abdominal  tumor  that 
"appeared  to  roll  from  side  to  side,"  but  that 
by  means  of  the  incision  it  was  possible  to 
discover 

"a  flattened  tumor  of  no  great  magnitude,  at  the  left 
sacro-iliac  synchonchosis  of  the  pelvis,  lying  beneath  the 
division  of  the  common  iliac  artery,  into  its  external  and 
internal  branches." 

By  this  little  pelvic  investigation  of  Mr.  Lizars 
he  did  more,  though  in  an  unconscious  way  (as 
implied  by  his  general  description)  to  prove  the 
vajue  of  the  long  incision,  embracing  both  the 
lower  and  upper  divisions  of  the  abdomen  (as 
opposed  to  old  incisionism),  than  McDowell 
had  ever  done  in  any  one  of  his  three  cases. 
Such  an  investigation  in  the  pelvis,  resulting  in 
such  a  diagnosis  of  the  growth  and  its  relations 
to  the  soft  parts  found  to  exist,  would  have  been 
wholly  impossible  by  the  incision  made  in  Dr. 
Smith's  case,  in  which,  in  his  history  of  the  sub- 
ject, Mr.  Lizars  gives  so  marked  a  degree  of 
prominence.  Could  Mr.  Lizars  only  have  ap- 
preciated this  fact,  and  brought  it  fairly  to  the 
notice  of  the  profession,  this  improved  mode  of 


400  MCDOWELL'S  OPERATION 

pelvic  investigation  would  have  gone  far  toward 
lessening  the  horror  created  on  all  sides  and  in 
all  directions  by  his  performance  of  such  an  un- 
necessary operation.  But,  as  it  was,  he  failed 
to  do  this  in  his  report  of  the  case,  and  by  the 
minute  description  of  certain  details  of  his  ope- 
ration which  might  just  as  well  have  been 
omitted,  he,  himself,  unconsciously  or  ignorantly, 
largely  contributed  toward  increasing  the  pre- 
judice at  that  time  existing  against  the  proce- 
jure,  as  will  presently  be  shown.  For  example, 
there  occurred  (as  in  McDowell's  first  case)  a 
protrusion  of  the  intestines  through  the  incision, 
and  he  descants  upon  this  as  follows  : 

"When  the  intestines  protruded,  and  baffled  all  the 
efforts  of  Dr.  Campbell  and  the  other  gentlemen  to  con- 
fine them,  I  shall  never  forget  the  countenances  of  my 
pupils  and  the  younger  members  of  the  profession.  This 
fact  of  the  intestines  being  forced  out  proves,  along  with 
others,  that  the  lungs  can  be  expanded  although  atmos- 
pheric air  be  admitted  into  the  abdominal  cavity;  the 
diaphragm  acted  with  great  vigor  and  with  powerful 
impetuosity." 

Fortunately  for  Mr.  Lizars,  however,  the 
poor  woman  recovered  from  her  operation  in 
the  course  of  three  or  four  weeks.  She  after- 
ward resumed  her  work,  "  earning  her  liveli- 
hood as  formerly,  by  binding  shoes,  but  often 
severely  tortured  with  pain." 


IN  GREA  T  BRITAIN.  40 1 

In  explanation  of  his  mistake  in  diagnosis 
and  his  unjustifiable  operation  Mr.  Lizars 
says  : 

"  The  reason  why  all  of  us  were  deceived  in  this  woman's 
case  was  the  great  obesity  and  distended  fullness  of  the 
intestines,  together  with  some  protrusion  pelvic  of  the 
spine  at  the  lumbar  vertebrae." 

Mr.  Lizars,  from  what  he  had  learned  from 
the  manuscript  of  McDowell  and  the  result  of 
his  own  case,  came  to  the  conclusion  "that 
there  is  little  danger  to  apprehend  in  laying 
open  the  abdominal  cavity,"  and  that  the  pro- 
cedure would  have  a  wide  range  of  applicability 
outside  the  employment  indicated — viz.,  for 
extrauterine  conception,  for  the  prevention  of 
embryulcia  of  the  fcetus  in  deformities  of  the 
pelvis,  for  aneurisms  involving  the  iliac  arteries 
and  aorta,  for  removal  of  foreign  bodies  from 
the  stomach,  for  volvulous,  for  internal  hernia, 
and  for  cancer  of  the  uterus.  He  considered 
the  dangers  resulting  from  delay  under  these 
circumstances  greater  than  would  result  from 
the  timely  employment  of  such  an  operation  as 
he  had  performed. 

The  following  year  Mr.  Lizars  published 
three  additional  cases  in  a  paper  entitled  "Ob- 
servations on  Extraction  of  Diseased  Ovaria  ; 
26 


4Q2 


MC  D  O  WEL  L '  S  OPERA  TION 


Illustrated  by  Plates  Colored   after  Nature."1 
A  brief  summary  of  the  cases  is  here  given  : 

Case  II. — Patient,  aged  thirty-six,  presented  herself  with 
a  tumor  in  the  left  side,  of  six  years'  standing  and  the  size 
of  a  foetus  at  full  term.  Operation  February  27,  1825. 
McDowell's  procedure;  full  exposure  of  the  peritoneal 
cavity ;  ligatures  on  the  pedicle  brought  out  in  lower  angle 
Of  wound.  Upon  examination  the  other  ovary  (right)  was 
found  to  be  also  diseased  and  about  one-fourth  the  size  of 
the  one  removed,  but  Mr.  Lizars  decided  for  some  reason 
not  to  remove  this,  probably  on  the  supposition  of  unwar- 
ranted risk.  The  wound  was  closed  in  the  usual  way  and 
the  patient  recovered. 

Case  III. — A  cookmaid,  aged  twenty-five,  presented 
herself  to  Mr.  Lizars  with  an  abdominal  tumor  of  six  years' 
standing.  McDowell's  operation,  March  22,  1825.  In 
this  instance  the  incision  was  curvilinear  through  the  broad 
muscles,  tendons  and  peritoneum.  Some  parietal  adhe- 
sions were  found,  but  these  were  easily  overcome  by  the 
fingers.  The  pedicle  was  the  size  of  the  little  finger.  It 
was  encircled  with  a  ligature  and  the  tumor  cut  away. 
The  wound  was  closed  with  sutures,  and  adhesive  strips, 
with  compress,  and  a  shawl  was  made  to  serve  as  a  binder. 
The  ends  of  the  ligatures  were  brought  out  at  the  lower 
angle  of  the  wound.  Peritonitis  supervened  and  the  pa- 
tient died  at  the  end  of  fifty-three  hours. 

Case  IV. — A  cookmaid,  aged  thirty-four,  presented  her- 
self to  Mr.  Lizars  with  an  abdominal  tumor  of  six  years' 
standing.  McDowell's  operation  performed  April  24, 
1825.  The  tumor  was  found  to  be  covered  by  the  great 
omentum,  in  which  numerous  bloodvessels,  varying  from 
the  size  of  the  finger  to  that  of  a  crow's  quill,  were  seen  to 

1  Abstract  of  the  same,  Edinburgh  Med.  and  Surg.  Journ., 
July,  1825;  also,  Archieves  Generale  de  Medecine,  t.  viii., 
P.  437- 


IN  G  RE  A  T  BRITAIN. 


403 


ramify.  No  attempt  was  made  to  dissect  the  omentum 
from  the  tumor,  and  further  efforts  to  complete  the  opera- 
tion, other  than  to  puncture  the  tumor  in  several  places 
(from  which  only  blood  escaped),  being  deemed  inadvisa- 
ble, the  wound  was  closed  and  dressed  as  in  the  preceding 
cases.     The  patient  recovered. 

It  is  proper  here  to  note  the  effect  which  the 
publication  by  Mr.  Lizars  of  McDowell's  first 
three  cases,  and  of  his  own  of  false  diagnosis 
and  unjustifiable  operation,  had  upon  the  pro- 
fession, judging  from  the  criticisms  and  ridicule 
found  in  the  Medico- Chirurgical  Review  for 
January,  1825,  and  October,  1826,  by  its  editor, 
Dr.  James  Johnson. 

Dr.  Johnson,  in  his  first  remarks  upon  the 
subject,  says  that  the  exploits  of  surgery  cannot 
always  be  accepted  as  real  advances,  and  ex- 
presses surprise  at  the  importance  attached  by 
Mr.  Lizars  to  the  operation  of  McDowell,  to 
whom  he  refers  slightingly  as  "Dr.  Mac"  and 
"Dr.  Macdowal,  of  Kentucky."  He  then  pro- 
ceeds to  accentuate  what  he  considers  the  im- 
probabilities of  McDowell's  statements,  espe- 
cially as  they  related  to  his  first  case,  that  of 
Mrs.  Crawford.  Thus,  the  patient  travelling 
sixty  miles  on  horseback  to  receive  the  care 
and  attention  of  Dr.  McDowell  at  his  own 
home  in  Danville,  and  having  her  abdomen  laid 


404 


MCD  O  WELD  S  OPERA  TION 


open  to  the  extent  of  nine  inches  ;  the  protru- 
sion of  her  intestines  for  twenty-five  minutes 
through  the  wound  made  in  her  abdomen  ;  the 
laying  open  of  the  tumor ;  the  excision  of  it  ; 
and  the  patient's  getting  up  on  the  fifth  day  to 
make  her  bed,  when  McDowell,  from  his  report, 
appears  to  have  made  his  first  visit,  were  all 
extraordinary  statements,  and  he  was  not  a 
little  surprised  that  Mr.  Lizars  "  should  put 
such  implicit  credence  in  them " ;  adding, 
Credat  yudceiis,  non  ego.  He  expresses  the 
same  incredulity  in  regard  to  McDowell's  state- 
ment of  the  management  of  his  second  case  of 
irremovable  tumor  (fibrous  growth  of  the 
uterus,  no  doubt),  in  which,  by  way  of  experi- 
ment he  "  plunged  the  scalpel  into  the  diseased 
part,"  and  found  "a  quart  or  more  of  blood 
escaped  into  the  abdomen." 

The  great  prejudice  of  Dr.  Johnson  against 
the  operations  and  results  described  by  Mc- 
Dowell is  further  illustrated  by  his  even  ignor- 
ing the  successful  case  of  Dr.  Nathan  Smith, 
the  report  of  which  appears  in  Mr.  Lizars's  first 
communication.  Mr.  Lizars's  description  of  his 
own  case,  however,  he  thought  was  altogether 
different  from  McDowell's  account  of  his  cases, 
and  the   fact  of  the  operation  by  Mr.   Lizars 


IN  GREAT  BRITAIN.  405 

being-  performed  and  no  tumor  found  he  recog- 
nized as  a  most  fortunate  circumstance,  because 
his  "patient  would  have  had  little  chance  of 
life."  As  it  was,  she  recovered,  "and  lives  to 
tell  the  tale."  After  quoting  Mr.  Lizars's  ex- 
planation of  the  cause  of  his  mistake  in  diag- 
nosis, he  concludes  : 

"Be  that  as  it  may,  we  do  not  think  that  the  cases 
brought  forward  in  this  paper  will  have  the  effect  of  ren- 
dering surgeons  more  bold  in  operating  for  the  removal  of 
abdominal  tumors,  whether  ovarian  or  of  any  other  kind." 

Just  after  the  publication  of  the  first  case  of 
Mr.  Lizars  the  able  work  of  Professor  James 
Blundell  appeared,  entitled :  Researches,  Physio- 
logical and  Pathological :  instituted  principally 
with  a  View  to  the  Improvement  of  Medical  and 
Surgical  Practice.  Dr.  Johnson,  in  a  lengthy- 
review  of  this  book  (April,  1825),  just  after  his 
strictures  upon  McDowell's  operations,  takes 
occasion  to  criticise  the  words  of  Professor 
Blundell  regarding  the  extirpation  of  dropsical 
ovaries : 

"And  if  British  surgeons  will  not  patronize  and  perform 
it,  the  French  and  American  surgeons  will ;  " 

making  use  of  the  extraordinary  statement  : 

"In  despite  of  all  that  has  been  written  respecting  this 
cruel  operation,  we  entirely  disbelieve  that  it  has  ever  been 
performed  with  success — nor  do  we  think  it  ever  will." 


4o6  MCDOWELL'S  OPERATION 

A  little  over  a  year  after  the  appearance  of 
Mr.  Lizars's  second  publication,  in  which  his 
three  additional  cases  are  recorded  (1825),  four 
years  after  Dr.  Nathan  Smith's  case  was  pub- 
lished (1822),  and  seven  years  after  the  publi- 
cation of  McDowell's  second  paper  (18 19), 
containing  the  report  of  his  fourth  and  fifth 
cases,  Dr.  Johnson,  in  his  second  editorial 
(1826)  seems  for  the  first  time  to  be  aroused 
to  the  injury  he  had  done  McDowell  and  his 
operation,  which  resulted,  as  he  indirectly  ad- 
mits, more  from  the  loose  manner  of  the  nar- 
ration of  his  cases  than  from  the  facts  stated. 
Here,  at  this  late  day,  he  endeavors  to  make 
amends  for  his  error,  as  shown  in  his  opening 
remarks  in  the  editorial  referred  to  : 

"A  back  settlement  of  America — Kentucky — has  beaten 
the  mother  country,  nay,  Europe  itself,  with  all  the  boasted 
surgeons  thereof,  in  the  fearful  and  formidable  operation 
of  gastrotomy  with  extraction  of  the  diseased  ovaria." 

Here  follows  a  brief  notice  of  McDowell's 
fourth  and  fifth  cases,  special  reference  being 
made  to  the  fourth,  in  which  ligatures  were 
"applied  to  several  arteries  individually,"  and 
also  to  the  fact  that  both  of  these  cases  were  in 
negr esses.  In  the  same  communication  he  intro- 
duces a  notice  of  Dr.  Nathan  Smith's  case,  the 


IN  GREA  T  BRITAIN.  407 

result  in  which  he  ignored  in  his  first  notice. 
He  also  mentions  the  successful  operation  in  a 
negress  by  Dr.  Alban  G.  Smith,  at  Danville, 
Kentucky,  which  he  speaks  of  as  "  still  the 
scene  of  operations." 

It  is  clear  from  reading  Dr.  Johnson's  second 
review  of  McDowell's  operations  that  he  was 
finally  forced  to  the  acknowledgment  of  his 
error  by  the  reply  to  his  first  remarks  by  Dr. 
Coates,1  in  which  the  latter  upheld  the  just 
claims  of  McDowell,  deduced  from  the  actual 
facts  of  his  five  cases,  four  of  which  recovered. 
"  For  which  uncharitableness  we  ask  pardon 
of  God  and  of  Dr.  Macdowal,  of  Danville,"  he 
exclaims  ;  but,  notwithstanding  this,  he  goes  on 
to  say  that  he  was  "in  good  company"  with 
"  Diemerbroeck  and  Sabatier,  who  believed  the 
operation  to  be  altogether  impracticable."  In 
the  same  connection  mention  should  be  made  of 
his  persistent  ridicule  of  the  large  proportion  of 
negresses  among  McDowell's  cases.     He  says: 

"  When  we  come  to  reflect,  that  all  the  women  operated 
upon  in  Kentucky,  except  one,  were  negresses,  and  that 
these  people  will  bear  cutting  with  nearly,  if  not  quite,  as 
much  impunity  as  dogs  and  rabbits,  our  wonder  is  lessened, 
and  so  is  our  hope  of  rivalling  Dr.  Macdowal  on  this  side 
of  the  Atlantic." 

1  North  America  Med.  and  Surg.  Journ.,  1826,  vol.  iii.,  p.  30. 


4o8  MCDOWELL'S  OPERATLON 

Next,  in  England,  following  in  the  footsteps 
of  Mr.  Lizars  in  the  employment  of  McDowell's 
operation  is  an  Italian  physician  living  in  Lon- 
don, by  the  name  of  Augustus  Bozzi,  but  better 
known  as  Dr.  A.  B.  Granville.  He  encountered 
two  cases  of  ovarian  dropsy  in  the  Westminster 
General  Dispensary,  where  he  was  one  of  the 
attending  physicians.  His  first  operation  was 
an  unfinished  one,  and  the  report  is  entitled : 
"  Case  in  which  an  Attempt  was  made  to  Ex- 
tirpate Ovarian  Tumors."1 

Case  V. — Operation  performed  July  i,  1826,  in  the 
presence  of  Mr.  Benjamin  Brodie,  Mr.  Keate,  Mr.  Earle, 
and  several  others.  Mr.  Brodie  had  previously  seen  this 
case  in  consultation  with  Dr.  Granville  and  they  both 
agreed  that  the  case  was  not  favorable  for  an  operation ; 
but,  nevertheless,  it  was  deemed  advisable  under  the  cir- 
cumstances. The  incision  made  was  seven  inches  and  a 
half  in  length,  in  the  left  side  external  to  the  rectus  muscle, 
and  made  in  accordance  with  the  teachings  of  McDowell. 
Dr.  Granville,  in  passing  his  hand  into  the  peritoneal 
cavity,  found  several  tumors  having  extensive  and  firm 
adhesions,  and,  therefore,  he  concluded  (in  which  opinion 
he  was  supported  by  the  surgeons  present,  who  examined 
the  condition  of  the  parts)  that  an  attempt  at  removal  of 
the  tumors  was  not  warranted.  The  wound  was  closed 
with  hare-lip  pins,  and  the  patient  recovered. 

The  report  of  the  case  concludes  in  these 
words : 

1  London  Medical  and  Physical  Journal,  1826,  vol.  lvi.,  p.  141. 


IN  GREAT  BRITAIN. 


4O9 


"As  far  as  it  goes,  this  case  adds  another  to  the  many 
instances  on  record  of  the  impunity  with  which  the  cavity 
of  the  abdomen  may  be  laid  open,  and  is  an  encouraging 
step  toward  attempting,  under  proper  circumstances,  and 
after  mature  deliberation,  an  operation,  which  Mr.  Lizars, 
of  Edinburgh,  has  the  merit  of  having  revived  on  rational 
grounds." 

Case  VI. — Entitled:  "Extraordinary  Surgical  Opera- 
tion."1 The  patient,  aged  forty,  presented  herself  to  Dr. 
Granville  for  treatment,  suffering  with  an  abdominal  tumor 
the  size  of  the  human  head.  McDowell's  long  incision 
was  employed,  as  in  the  preceding  case,  March  21,  1827, 
in  the  presence  of  Mr.  Keate,  Mr.  Eade,  Mr.  Patterson, 
and  several  other  physicians.  The  tumor  weighed  eight 
pounds  and  was  removed  entire.  The  patient  died  seventy- 
two  hours  after  the  operation  from  exhaustion  due  to  ex- 
cessive loss  of  blood  from  venesection  by  an  over-zealous 
student,  who  thought  peritonitis  was  present. 

In  connection  with  Dr.  Granville's  two  opera- 
tions it  is  proper  to  state  the  fact  that  some 
fifteen  years  after  the  date  of  his  second  opera- 
tion he  found  himself  compelled  to  defend  his 
claims  to  having  been  the  first  in  England  to 
perform  ovariotomy.2  This  he  did  in  answer 
to  the  statement  made  by  Mr.  D.  Henry 
Walne3  that  after  Mr.  Lizars  the  operation  of 
ovariotomy  sunk  into  a  state  of  apathy,  so  to 
speak,  and  was  not  revived  by  any  British  sur- 
geon   until   within   a   few  months   previously, 

1  Literary  Gazette,  March  31,  1827. 

2  London  Medical  Gazette,  1842-43,  vol.  xxxi. 

3  Op.  cit. 


4I0  MCDOWELL'S  OPERATLON 

when  Dr.  Clay  (September  12,  1842)  per- 
formed an  ovariotomy,  followed  by  his 
(Walne's)  a  few  months  later  (November  6). 
To  this  Dr.  Granville  replies :  "  Mr.  Walne 
assumes  the  credit  which  belongs  to  another," 
and  in  support  of  his  claim  he  adduces  the  facts 
as  brought  out  in  the  above  two  cases. 

Of  the  various  publications  credited  to  Dr. 
Granville,  from  18 19  to  1858,  it  is  curious  to 
note  that  not  one  is  mentioned  as  bearing  upon 
the  operation  of  ovariotomy,  nor  is  any  refer- 
ence made  to  the  two  operations  performed  by 
him  in  London  in  The  Roll  of  the  Royal  College 
of  Physicians  of  London  (of  which  College  he 
was  a  member),  which  contains  a  biographical 
sketch  of  him. 

The  next  British  surgeon  in  order  who  was 
led  to  adopt  the  long  incision  of  McDowell  is 
Mr.  R.  C.  King,1  of  Saxmundham,  Suffolk, 
England,  as  appears  from  his  communication 
entitled:  "New  Operations  for  the  Removal  of 
Abdominal  Tumors."  His  reasons  given  for 
reporting  the  appended  cases  are  principally  to 
show  the  safety  of  the  operation,  and  to  en- 
courage further  efforts  in  the  employment 
of  it: 

1  Lancet,  Jan.   7,   1837,  vol.  i.,  p.  586. 


IN  GREA  T  BRITAIN'. 


411 


Case  VII. — This  patient  (the  first)  presented  herself  to 
Mr.  King  with  a  large  and  irregular  tumor,  with  general 
distention  of  the  abdomen  and  distinct  fluctuation.  After 
four  tappings,  from  which  relief  always  resulted,  partially 
as  to  the  embarrassed  breathing,  an  operation  for  the  re- 
moval of  the  tumor  was  decided  upon.  Dr.  Field  and 
several  other  physicians  were  present,  and  assisted  in  the 
operation.  A  long  incision  was  made  along  the  left  linea 
semilunaris,  through  which  a  considerable  quantity  of 
ascitic  fluid  escaped,  together  with  the  omentum.  Whilst 
he  was  endeavoring  to  return  the  omentum  the  patient 
"became  discomposed,  and  expressed  a  wish  that  the 
attempt  might  be  abandoned."  Accordingly,  as  soon  as 
the  omentum  was  returned  the  wound  was  closed,  and, 
although  the  patient  recovered  from  the  unfinished  opera- 
tion, she  died  from  exhaustion  a  few  months  afterward. 

Case  VIII. — Mr.  King's  second  case  was  Sophia  Put- 
tock,  aged  forty,  who  presented  a  "  movable  abdominal 
tumor. ' '  It  was  in  the  right  side,  oval  in  form,  and  four 
or  five  inches  in  its  longest  diameter.  Mr.  William  Jeaf- 
freson,  of  Framlingham,  who  was  called  in  consultation  to 
see  the  case,  corroborated  the  diagnosis  of  Mr.  King,  and 
expressed  the  opinion  that  removal  of  the  tumor  was  called 
for.  Operation,  March,  1834.  Present,  Mr.  Jeaffreson, 
Mr.  Lanchester,  and  five  other  physicians.  An  incision, 
seven  or  eight  inches  in  length,  was  made  along  the  right 
semilunaris.  The  tumor  not  being  found  through  this 
incision,  it  was  enlarged  transversely  toward  the  lumbar 
vertebrae.  Further  search  for  the  tumor  was  made  in  the 
direction  of  the  liver  and  right  kidney,  the  latter  being 
"handled  and  held  up  two  inches,"  but  nothing  of  a  dis- 
eased character  could  be  discovered.  The  peritoneal 
cavity,  in  this  fruitless  examination,  was  exposed  about 
twenty  minutes.  The  wound  was  closed  with  sutures, 
and  the  patient  made  a  speedy  recovery. 

Mr.  King-  states  that  in  his  abdominal  search 


^12  MCDOWELL'S  OPERATION 

for  the  tumor  he  neglected  to  elevate  the  hips 
of  his  patient,  which  might  have  caused  the  dis- 
lodgementof  the  tumor  from  the  pelvis,  where  it 
was  probably  concealed,  and  suggests  that  this 
precaution  might  prove  of  advantage  to  other 
surgeons  placed  under  like  circumstances.  Mr. 
King  further  states  that  at  the  end  of  two  or 
three  years,  when  he  reported  the  case,  notwith- 
standing the  increase  of  the  tumor  from  one- 
fourth  to  one-third  beyond  its  former  size,  the 
patient  was  in  better  health,  and  suffered  less, 
than  at  the  time  of  his  unfinished  operation,  a 
fact  which  he  attributes  to  the  relaxation  of  the 
abdominal  wall  on  the  right  side,  resulting  from 
imperfect  union  of  the  edges  of  the  wound,  the 
cicatrix  being  formed  simply  by  the  integu- 
ments. 

Mr.  King's  third  case  will  be  presented  further 
on,  for  the  reason  that  the  extirpation  of  the 
diseased  ovary  was  effected  by  the  short  inci- 
sion. This  was  previously  suggested,  as  has 
been  shown,  by  Dr.  William  Hunter,  as  the 
outgrowth  of  the  old  method  of  incisionism. 
Mr.  King,  however,  attributes  the  credit  of  the 
procedure  to  his  friend,  Mr.  William  Jeaffreson, 
stating  that  he  had  previously  operated  upon 
a  case  by  the  short  incision,  and'  that  it  was 


IN  GREA  T  BRITAIN.  4  !  3 

upon  the  result  of  this  that  his  case  followed,  as 
"a  scion  grafted  upon  the  parent  stock." 

Mr.  Jeaffreson,  in  his  report1  of  the  case  re- 
ferred to,  entitled  :  "  A  Case  of  Ovarian  Tumor 
Successfully  Removed,"  states  that  in  an  expe- 
rience of  thirty  years  he  had  met  with  about 
twenty  cases  of  dropsical  ovaries,  and  that  the 
tendency  of  all  of  them  was  to  a  fatal  termina- 
tion, after  varying  periods  of  protracted  suffer- 
ing. The  treatment  employed,  consisting  prin-  , 
cipally  of  tapping,  although  affording  temporary 
relief,  was  at  best  only  a  "forlorn  hope,"  not- 
withstanding the  contrary  claims  made  by  Sir 
Astley  Cooper,  Dr.  Haighton,  and  a  few  others. 
He  then  states  that  he  was  cognizant  of  the 
fact  that  "  Dr.  Smith  once  performed  this  opera- 
tion with  success,"  and  goes  on  to  say  that 
"  Mr.  Lizars  had  published  many  interesting 
cases  of  extirpation  of  the  ovary,"  thus  show- 
ing that  he  must  have  been  ignorant  of  Dr. 
McDowell's  original  operation,  or  that  he  con- 
siders its  special  features  of  no  practical  advan- 
tage. In  giving  his  own  views  he  says  :  "It  has 
often  occurred  to  my  mind  that  the  operation 
might  be  had  recourse  to  so  soon  as  the  sac  was 
sufficiently  distended  as  to  press  firmly  on  the 

1  Trans.  Prov.  Med.  and  Surg.  Asso.,  1837,  vol.  v.,  p.  239. 


414  MCDOWELL'S  OPERATION 

parietes  of  the  abdomen,  and  before  adhesions 
had  taken  place."  He  states  that  he  was  led, 
in  1833,  to  this  conviction  from  meeting  with  a 
case  of  ovarian  dropsy,  complicated  with  preg- 
nancy at  full  term,  in  which  the  descent  of  the 
tumor  retarded  the  process  of  labor  until  he 
lifted  it  up  with  his  finger,  and  thus  overcame 
this  grave  obstacle  to  the  passage  of  the  child's 
head.  This  woman  died  a  few  days  afterward, 
and  as  an  illustration  of  the  soundness  of  his 
convictions,  just  stated,  he  rehearsed  at  the 
autopsy  the  stages  of  an  operation  by  which 
he  believed  the  woman's  life  might  have  been 
saved. 

The  plan  indicated,  and  which  he  proposed 
to  follow  when  the  opportunity  again  offered, 
embodied  these  features  :  First,  to  make  an 
incision  in  the  linea  alba  midway  between  the 
umbilicus  and  the  pubes,  about  an  inch  in 
length  ;  second,  to  expose  and  puncture  the 
cyst  with  a  trocar  ;  third,  during  the  flow  of  the 
fluid,  to  seize  a  portion  of  the  cyst  wall  "  in  the 
grip  of  the  forceps "  ;  fourth,  the  sac  being 
emptied,  to  draw  it  gradually  through  the 
opening,  puncturing  any  other  cyst  or  cysts  as 
they  presented  themselves  ;  fifth,  to  include  the 
pedicle  in  a  ligature,  cutting  the  ends  "off  close 


IN  GREA  T  BRITAIN.  4  T  5 

to  the  knot"  and  dropping  the  pedicle  "into 
the  cavity  of  the  abdomen  "  ;  and,  sixth,  in  the 
after-treatment  to  use  large  doses  of  opium 
with  foxglove,  "  keeping  a  napkin  wrung  out  of 
the  coldest  spring- water  constantly  applied  over 
the  whole  of  the  abdomen,"  as  first  recom- 
mended by  Mr.  King.  With  these  preliminary 
statements,  he  proceeds  to  narrate  his  case : 

Case  IX. — In  November,  1833,  Mr.  Jeaffreson  was 
called  to  see  Mrs.  B.  in  her  second  confinement,  and,  by 
an  extraordinary  coincidence,  he  discovered  the  case  to 
be  similar  to  the  one  just  referred  to  as  terminating  fatally. 
The  same  line  of  treatment  was  pursued  with  success,  and 
the  child  delivered  without  difficulty.  His  friend,  Mr. 
King,  was  called  in  consultation.  Nearly  three  years 
afterward  (March  4,  1836),  Mr.  Jeaffreson  was  again 
called  in  to  attend  Mrs.  B.  in  her  confinement,  and  the 
child  was  born  without  difficulty.  But  he  was  surprised  to 
find  afterward  that  the  size  of  the  abdomen  was  but 
slightly  diminished,  a  circumstance  due  to  the  gradual 
augmentation  of  the  dropsical  ovary  during  the  interval 
that  had  intervened  between  the  two  labors.  After  a  lapse 
of  two  months,  during  which  time  all  the  ordinary  reme- 
dies for  promoting  absorption  of  the  fluid  present,  includ- 
ing veratria,  so  highly  extolled  by  Dr.  Turnbull,  had  been 
resorted  to  without  permanent  benefit,  the  patient  decided 
to  submit  to  an  operation  for  removal  of  the  tumor. 
Operation  by  Mr.  Jeaffreson,  May  8,  1836,  assisted  by  Mr. 
King.  The  incision  made  was  said  to  be  "between  ten 
and  twelve  lines."  The  different  steps  of  the  operation 
were  carried  out  as  in  the  plan  previously  described,  and 
the  wound  closed,  only  two  sutures  being  called  for.  The 
patient  perfectly  recovered. 


41 6  MCDOWELL'S  OPERATION 

Mr.  JeafTreson  goes  on  to  state  that  after  the 
recovery  of  his  patient  he  received  a  thesis 
written  by  Dr.  Charles  Frederick  Quittenbaum, 
on  the  successful  treatment  of  a  case  of  drop- 
sical ovary  operated  upon  November  18,  1834, 
but  he  (JeafTreson)  had  the  same  objection  to 
this  operation  that  he  had  to  those  of  Mr. 
Lizars,  viz.  :  "  The  greater  extent  of  the  incision 
and  consequent  hazard  to  the  patient,"  referring 
here,  of  course,  to  the  McDowell  incision.  He 
then  concludes  the  report  of  his  case  by  saying 
that  if  he  had  met  with  extensive  adhesions 
between  the  cyst  and  the  surrounding  viscera 
he  would  have  established  a  communication 
between  the  former  and  the  peritoneal  cavity, 
thus  leaving  the  diseased  organ  to  be  cured  by 
peritoneal  absorption.  In  this  is  seen  the  most 
pointed  acknowledgment  of  the  defectiveness 
of  the  Hunterian  short  incision  he  had  just 
adopted  in  the  face  of  a  difficulty  that  would 
not  have  been  of  the  slightest  consequence  in 
the  employment  of  McDowell's  long  incision. 
The  expedient  here  referred  to,  of  establishing 
a  communication  between  the  cyst  and  the 
peritoneal  cavity  in  cases  otherwise  irremedi- 
able by  the  short  incision,  was  a  proposal  pre- 
viously made  by  Prof.  Blundell. 


IN  GREA  T  BRITAIN.  4  :  j 

Mr.  Jeaffreson  here  mentions  the  case  of  Mr. 
R.  C.  King  previously  referred  to  by  the  latter, 
as  "a  scion  grafted  on  the  parent  stock,"  and 
which  now  follows  in  regular  order. 

Case  X. — Mr.  King's  third  case,  entitled  "Ovarian 
Dropsy ;  Removal  of  the  Cyst ;  Employment  of  Cold  and 
Foxglove  after  Operation."1  H.  C,  a  teacher,  aged 
thirty-seven,  applied  to  Mr.  King,  in  August,  1833.  She 
presented  an  enlargement  of  the  abdomen,  with  fluctua- 
tion. Mr.  King  says  that,  previous  to  seeing  Mr.  Jeaffre- 
son's  case,  he  had  decided  to  allow  this  patient  to  go  on 
until  she  was  incapacitated  from  her  duties,  and  then  tap 
her  to  obtain  the  usual  temporary  relief;  but  the  result  of 
Mr.  Jeaffreson's  case  proving  so  satisfactory,  he  was  led  to 
perform  the  same  operation  without  further  delay.  Oper- 
ation July  12,  1836,  at  which  Mr.  Jeaffreson  was  present 
and  assisted.  The  operation  was  virtually  the  same  as  that 
of  the  latter,  except  that,  after  drawing  off  twenty-seven 
pints  of  gelatinous  fluid,  he  had  to  enlarge  his  incision  to 
three  inches  in  order  to  extract  the  sac.  It  should  also  be 
stated  that,  after  applying  the  ligature  to  the  pedicle  in 
mass,  it  slipped  off  and  had  to  be  reapplied,  which  was 
done  on  the  arteries  individually,  one  of  which  was  the 
size  of  the  ulnar  artery.  The  three  ligatures  applied  were 
cut  off  close  to  the  knots,  and  the  pedicle  returned  to  the 
abdomen.  The  bleeding  was  slight.  After  the  operation 
Mr.  King  gave  two  drachms  of  tincture  of  foxglove  and 
one  of  laudanum ;  and  immediately  after  the  operation 
began  the  application  to  the  entire  abdomen  of  thick 
cloths  wrung  out  of  ice-water,  frequently  renewed.  Sec- 
ond day,  little  or  no  tenderness  of  the  abdomen;  pulse  60. 
At  no  time  since  the  operation  had  the  pulse  exceeded  64. 
But  little  nausea  or  hiccough.     On  the  third  day  condi- 

1  Op.  cit.,  January  7,  1837. 
27 


4i8 


MCDOWELL'S  OPERATION 


tion  of  patient  normal,  and  from  this  time  on  convales- 
cence was  as  satisfactory  as  it  was  possible  to  be.  Patient 
cured. 

Mr.  King-  concludes  the  report  of  this  case 
with  the  following  remarks  : 

"These  cases  will,  I  think,  materially  add  to  our  confi- 
dence in  the  powers  of  the  human  frame  to  dispose  of 
ligatures  when  left  in  cavities The  applica- 
tion of  the  ice-water  was  continued  incessantly  to  the 
abdomen ;  it  was  injected  into  the  rectum  and  colon 
in  large  quantities  and  frequently.  Nutritious  fluids  of 
animal  broth,  milk,  and  gruel  were  likewise  given  through 
the  same  medium.  Foxglove  acted  very  favorably  in 
overcoming  the  tendency  to  quickened  circulation,  and  it 
was  frequently  repeated  during  the  first  fortnight,  although 
chiefly  through  the  medium  of  the  bowels  in  consequence 
of  the  irritability  of  the  stomach.  It  would  be  occupying 
too  much  of  your  publication  to  add  my  observations  on 
the  use  of  cold  and  foxglove  to  counteract  inflammatory 
tendencies,  either  after  operation  or  in  idiopathic  inflam- 
matory disease,  but  I  think  there  will  be  little  difficulty  in 
showing  that,  when  fully  and  assiduously  used,  they  have 
most  important  and  controlling  powers  in  arresting  the 
march  of  the  destroying  power  of  inflammatory  disease, 
chronic  or  acute." 

Mr.  W.  J.  West,  of  Tunbridge  Wells,  was 
the  next  to  report  a  case  of  ovariotomy,  and  it 
was  entitled,  "Successful  Operation  for  the 
Removal  of  an  Ovarian  Tumor."  *  He  pre- 
cedes the  narration  of  his  case  by  reference  to 

1  Lancet,  1837-38,  vol.  i.  p.  307. 


IN  GREA  T  BRITAIN. 


419 


the  two  published  reports  of  the  cases  of 
Messrs.  Jeaffreson  and  King,  and  to  the  objec- 
tions that  had  been  made  to  the  report  of  the 
former  by  the  London  University  Medical 
Society.1 

Case  XI. — Mrs.  H.,  aged  forty-four,  was  attended  by 
Mr.  West  in  her  third  confinement,  the  pregnancy  being 
complicated  by  a  tumor  in  the  abdomen  of  thirteen  years' 
standing.  Mr.  West  had  previously  examined  the  patient, 
and  knew  the  character  of  the  tumor.  She  had  consulted 
several  surgeons,  and  had  been  treated  by  a  seton,  as 
recommended  by  Dr.  Barnard,  and  by  various  other 
remedies.  Operation  November  2,  1837,  Mr.  West  being 
assisted  by  Dr.  Scudamore  and  Mr.  Hargraves,  also  of 
Tunbridge  Wells.  Incision  in  the  linea  alba  below  the 
umbilicus,  two  inches  in  length ;  then  the  tumor  was 
exposed  and  secured  by  a  loop  of  cord  fixed  in  the  sub- 
stance of  the  wall,  preparatory  to  puncturing  the  cyst  with 
a  trocar.  Twenty  pints  of  fluid  were  drawn  off,  when,  by 
very  little  traction  on  the  loop,  the  emptied  cyst  was 
extracted  from  the  peritoneal  cavity.  A  ligature  was 
applied  to  the  pedicle  in  mass,  the  ends  cut  off  close  to  the 
knot,  and  the  tumor  removed,  the  pedicle  being  returned 
to  the  abdominal  cavity.  Four  sutures  were  used  for 
closing  the  wound,  which  was  also  supported  by  strips  of 
adhesive  plaster.  In  the  after-treatment  "  cold  spirituous 
lotions  were  constantly  applied  over  the  abdomen,"  and 
calomel  with  saline  aperients  were  given  for  keeping  the 
bowels  open.     Patient  was  discharged  cured. 

In  Mr.  West's  concluding  remarks  he  sum- 
marizes the  objections  of  the  London  University 
Medical  Society  referred  to  regarding  Mr.  Jeaf- 

1  Lancet,  January  7,  1837. 


420  MCDOWELL'S  OPERATION 

freson's  plan  of  operating.  They  were  :  First, 
inapplicability  of  the  procedure  when  adhesions 
had  formed ;  second,  "  the  danger  of  perito- 
nitis "  ;  third,  "  when  the  cysts  are  numerous  "; 
and  fourth,  "  the  disease  being-  complicated  with 
other  tumors." 

Mr.  West  performed  three  other  operations 
according  to  the  suggestions  of  Mr.  Jeaffreson, 
which  are  not  reported  in  detail,  but  he  fur- 
nished Mr.  John  Gorham,  of  Tunbridge,  Kent, 
for  publication,  the  essential  points  of  his  treat- 
ment and  the  results,  which  the  latter  recorded, 
together  with  the  cases  of  Dr.  Nathan  Smith, 
Mr.  Jeaffreson,  Mr.  Hargraves,  and  the  case  in 
Guy's  Hospital,  in  an  article  entitled:  "Obser- 
vations on  the  Propriety  of  Extirpating  the 
Cyst  in  Some  Cases  of  Ovarian  Dropsy."1 

Case  XII. — Mr.  West's  second  case,  Miss  S.,  aged  twenty- 
five,  presented  an  abdominal  tumor  with  distinct  fluctua- 
tion. Short  incision,  exposure  of  the  cyst,  and  emptying 
the  sac  (which  contained  twenty-four  pints  of  fluid),  car- 
ried out  as  in  the  preceding  case.  No  unfavorable  symp- 
toms attended  the  after-treatment.     The  patient  was  cured. 

Case  XIII. — Mr.  West's  third  case.  Mrs.  Tompkins, 
aged  forty,  had  an  abdominal  tumor  which  had  previously 
been  tapped.  Short  incision.  Adhesions  found  and  no 
attempt  made  to  remove  tumor,  which  was  probably  mul- 
tilocular   and,    therefore,   unsuitable    for    short   incision. 

1  Lancet,  1839-40,  vol.  i.,  p.  155. 


IN  GREAT  BRITAIN. 


421 


Wound   was    closed    and    patient   recovered.       She   was 
tapped  seventeen  times  afterward. 

Case  XIV. — Mr.  West's  fourth  case.  A.  M.,  aged 
twenty-four.  Similar  case  to  his  third,  and  short  incision 
was  made.  "  Sac  contained  eleven  gallons  and  her  con- 
stitution was  much  shattered."  Mr.  West's  statements  to 
Mr.  Gorham  regarding  this  case  are  vague,  but  enough  is 
brought  out  to  -show  that  the  tumor  was  multilocular  in 
character,  and,  therefore,  unsuited  for  removal  by  the 
short  incision.  Eight  pints  of  fluid  withdrawn.  Tumor 
was  not  removed.  "  Tapped  repeatedly  before  she 
sank." 

In  this  connection  Mr.  Gorham  refers  to  two 
other  cases,  the  details  of  which  are  unpub- 
lished :  that  of  Mr.  Hargraves,  and  the  one  in 
Guy's  Hospital. 

Case  XV. — The  case  of  Mr.  Hargraves,  of  Tunbridge 
Wells.  A.  B.,  aged  forty.  Fluctuation  distinct  in  the 
abdomen.  The  solid  portion  of  the  tumor  could  be  felt 
through  the  abdominal  wall.  Short  incision  made.  Pres- 
ent Mr.  Gorham.  Tumor  found  with  adhesions.  Opera- 
tion abandoned  and  wound  closed.  Tumor  was  probably 
multilocular  and,  therefore,  unsuited  for  removal  by  short 
incision. 

Case  XVI. — Patient  in  Guy's  Hospital.  Operation 
(unfinished)  was  performed  in  1839.  Fluctuation  of 
tumor  distinct.  Short  incision  as  in  the  preceding  casqs. 
More  extensive  exploration,  and  greater  traction  made 
than  was  thought  justifiable.  The  tumor  being  probably 
multilocular,  the  operation  was  unfinished.  Patient  died, 
and  the  autopsy  showed  but  slight  adhesions.  Tumor  un- 
suited for  the  short  incision.  Operator  not  named,  but  sup- 
posed to  have  been  Mr.  Morgan,  and  the  case  was  the  first 
one  operated  upon  in  any  of  the  great  hospitals  of  London. 


422 


MC  D  O  WEL  L '  S  OPERA  TION 


Mr.  West  exhibited  at  Guy's  Hospital  the  specimen  of  the 
cyst  removed  in  his  first  case  in  1839,  and  there  is  con- 
siderable direct  evidence  that  Mr.  Morgan,  who  was  at 
that  time  one  of  the  surgeons  at  Guy's,  performed  the 
operation  in  question. 

After  the  publication  of  Mr.  Gorham's  ten 
cases,  and  his  comments  upon  them  and  their 
results,  accompanied  by  an  allusion  to  the  prior 
proposal  of  Dr.  William  Hunter  in  connection 
with  the  possible  extirpation  of  dropsical  ovaries 
by  a  short  incision,  Mr.  Jeaffreson,  feeling  that 
these  remarks  reflected  upon  his  originality, 
addressed  a  letter  to  the  editor  of  the  Lancet 
(November  2,  1839)  upon  the  subject,  in  an- 
swer to  Mr.  Gorham,  in  which  he  says  : 

"I  beg  to  say  that  I  was  perfectly  sincere  in  claiming 
the  more  simple  mode  of  operating  in  these  cases  as  a  sug- 
gestion of  my  own  mind,  never  having  seen  or  heard  of 
Dr.  Hunter's  paper  on  the  subject.  Indeed,  I  think  that 
it  is  the  deference  which  has  been  paid  to  the  gigantic 
authority  of  John  Hunter,  more  particularly  to  his  theory 
of  '  Continuous  Sympathy,'  which  has  kept  abdominal 
surgery  in  comparative  abeyance." 

,  Mr.  Gorham,1  in  his  rejoinder  to  Mr.  Jeaffre- 
son, disclaims  any  intention  of  reflecting  upon 
the  merits  of  Mr.  Jeaffreson's  proposal  of  the 
short  incision,  and  admits  the  looseness  of  his 
statements  regarding  the  prior  suggestions  of 

1  Lancet,  Dec.  9,  1839. 


IN  GREAT  BRITAIN.  423 

Dr.  Hunter.  This  done,  he  expresses  his  ap- 
preciation of  Mr.  Jeaffreson's  contribution  to 
science  in  these  words  : 

"It  does  seem  we  are  indebted  not  only  for  what  we 
know  of  real  utility  and  benefit,  as  regards  this  particular 
operation,  but  also  for  opening  to  us  a  new  era  in  the 
surgery  of  the  abdomen." 

In  the  letter  of  Mr.  Jeaffreson's  just  referred 
to  he  alludes  to  a  successful  operation  of  "  ex- 
tirpation of  an  ovarian  cyst,"  by  his  friend, 
Mr.  Crisp,  of  Harleston,  Norfolk,  and  this  is 
here  introduced  in  its  regular  order. 

Case  XVII. — This  patient  consulted  Mr.  Crisp  in  re- 
gard to  an  abdominal  tumor  of  about  twenty  years'  stand- 
ing, and  for  which  she  had  submitted  to  two  tappings. 
Length  of  incision  supposed  to  be  short.  No  adhesions 
found  with  surrounding  viscera,  or  from  previous  tappings. 
Cyst  punctured,  and  three  gallons  of  fluid  drawn  off,  after 
which  the  collapsed  cyst  was  removed  without  difficulty. 
Perfect  cure. 

Next  follows  Mr.  Benjamin  Phillips's  case. 
His  report  is  entitled  :  "  Extraction  of  an  Ova- 
rian Cyst."1  Mr.  Phillips  in  the  prefatory 
remarks  to  the  report  of  his  case,  deprecates 
in  a  commendable  way  the  reprehensible  ten- 
dency of  surgeons  to  report  only  their  suc- 
cessful cases,  "as  if  any  moral  imputation  could 

1  London  Med.  Gaz.,  1840-41,  vol.  xxvii.,  p.  83. 


424  MCDOWELL'S  OPERATION 

attach  to  failure  in  cases  where  failures  must 
often  happen."  He  considered  such  a  practice 
not  only  "immoral,"  but  tending  to  retard  the 
true  and  legitimate  advance  of  the  art  of  sur- 
gery. Without  going  into  the  history  of  the 
operation  for  extirpation  of  ovarian  cyst,  he 
says  : 

"  For  all  practical  purposes  it  is  sufficient  to  assume  that 
to  Mr.  Jeaffreson  (1836)  belongs  any  merit  which  may- 
attach  to  the  plan  of  treating  these  cysts,  by  extraction 
through  a  short  incision  in  the  abdominal  parietes." 

Case  XVIII. — A.  D.,  aged  twenty-one,  with  an  abdomi- 
nal tumor,  having  previously  consulted  several  surgeons  in 
London,  among  whom  were  Mr.  Liston  and  Dr.  Hamilton 
Roe,  finally  came  through  the  latter  to  Mr.  Phillips.  No 
question  as  to  diagnosis.  Operation  by  Mr.  Phillips,  Sep- 
tember 9,  1840,  at  which  were  present  and  assisted  Drs. 
Roe,  Clendening,  Harrison,  and  Messrs.  Prichard,  Brown, 
and  several  others.  Short  incision  below  the  umbilicus, 
an  inch  and  a  half  in  length.  Cyst  exposed,  seized  with 
forceps,  punctured  with  trocar,  and  three  '  hundred  and 
thirty  ounces  of  transparent,  glairy  fluid  drawn  off;  no 
adhesions,  but  walls  of  cyst  found  thick,  requiring  the 
opening  to  be  enlarged  a  little  so  as  to  facilitate  extraction. 
Pedicle  small,  firmly  tied  with  a  ligature,  ends  cut  off  close 
to  the  knot,  tumor  removed,  and  the  pedicle  allowed  to 
return  to  the  abdominal  cavity.  Wound  closed  with 
sutures.  After  the  operation  the  patient  almost  im- 
mediately began  to  complain  of  pain  in  the  right  iliac 
fossa.  On  the  third  day  she  was  attacked  with  severe 
diarrhoea,  a  "  choleriform  affection,"  for  which  opium  and 
astringents  were  freely  given,  and  twelve  leeches  applied. 
Case  terminated  fatally  at  the  end  of  one  hundred  and 


IN  GREA  T  BRITAIN. 


425 


three  hours.  Autopsy  showed  the  ligature  of  the  pedicle 
to  be  in  place,  but  eight  ounces  of  blood  in  the  peritoneal 
cavity. 

Summary  of  cases  and  results  in  Great 
Britain  of  extirpation  of  dropsical  ovaries  by 
McDowell's  procedure,  including  alike  those 
operated  upon  by  the  long  and  short  incisions : 
9  completed  operations,  with  6  cures  and  3 
deaths  ;  8  unfinished  operations,  with  7  recov- 
eries and  1  death  ;  1  unjustified  operation,  with 
recovery.     Mortality  of  completed  operations, 

33-33  Per  cent- 

Comments. — Encysted  dropsy  of  the  ovary  as 
distinguished  from  general  dropsy,  or  ascites, 
was,  as  we  have  seen,  first  recognized  as  such, 
and  successfully  treated  by  incision  and  drain- 
age, in  a  woman,  Margaret  Millar,  aged  fifty- 
eight,  residing  near  Glasgow,  Scotland,  by  Dr. 
Robert  Houston,  in  August,  1701.  To  Great 
Britain,  it  is  believed,  is  justly  due  the  credit  of 
first  adopting  the  practice  designated  as  inci- 
sionism,  and  the  circumstances  of  Houston's 
operation,  with  the  result  noted,  mark  an  im- 
portant era  in  the  history  of  the  subject,  not 
only  on  account  of  its  being  the  first  case  in 
which  incisionism  was  employed,  but  from  the 
influence  it  had  upon  the  practice  of  other  coun- 


426  MCDOWELL'S  OPERATLON 

tries,  leading,  as  it  did,  to  the  proposal  of  ex- 
tirpation of  the  ovary  nearly  half  a  century  later 
in  France.  In  still  another  particular  the  case 
is  important,  as  has  been  shown,  viz.,  in  its 
having  been  claimed  by  one  writer  over  a  hun- 
dred years  later  as  a  case  of  successful  ovari- 
otomy by  the  long  incision,  and  again  by 
another  only  a  few  years  ago,  who  made  the 
same  claim  on  the  assumption  that  a  namesake 
of  this  old  Scotch  physician  had  catalogued,  in 
a  most  creditable  way,  the  anatomical  museum 
of  a  school  of  surgery. 

In  the  contribution  of  Dr.  William  Hunter, 
offering  a  more  advanced  explanation  of  the 
pathology  of  ovarian  dropsy,  with  his  sugges- 
tion of  the  possibility  of  extirpating  a  simple 
and  small  cyst  through  a  short  incision  in  the 
abdomen,  there  is  much  of  practical  value  to 
commend,  and  for  this  also  Great  Britain  has  a 
just  claim  of  credit,  his  position  being  on  the  line 
of  advancement  through  old  incisionism,  as 
inaugurated  by  Houston.  This  theoretical  pro- 
position of  Hunter,  however,  was  not  accepted 
by  any  surgeon  of  that  country,  nor  was  even  a 
trial  of  it  made  there,  until  extirpation  of  drop- 
sical ovaries  became  a  settled  fact  three-quarters 
of  a    century    later.       Nevertheless,    it  was   a 


IN  GREAT  BRITAIN.  427 

movement  in  the  right  direction,  as  proven  by 
the  readiness  with  which  surgeons  took  up  the 
short  incision  in  the  lower  division  of  the  abdo- 
men, as  proposed  by  Hunter,  after  McDowell 
had  demonstrated  the  practicability  of  his  oper- 
ation by  the  long  incision.  How  much  Mc- 
Dowell profited  by  the  teachings  of  Hunter  it 
is  difficult  to  say,  but  the  boldness  displayed  by 
him  in  his  first  movement  of  securing  the  widest 
exposure  of  "the  focus  of  the  disease,  namely, 
the  tumor  formed  by  the  ovary,"  as  suggested 
by  Delaporte,  shows  conclusively  that  to  master 
adhesions  and  to  avoid  injuries  of  the  surround- 
ing organs  were  with  him  considerations  of 
paramount  importance,  a  conception  of  the 
operation  far  beyond  the  simple  thought  of  a 
short  incision  involving  all  the  dangers  incident 
to  tugging  at  and  dragging  through  such  an 
opening  a  tumor  of  unknown  dimensions.  Fur- 
ther proof  that  the  conception  of  McDowell  was 
independent  of  any  ideas  derived  from  Hunter 
is  shown  in  the  fact  that  he  made  an  entrance 
into  the  abdomen  above  the  tumor,  so  to  speak, 
instead  of  below,  as  had  been  advocated  by 
Hunter,  and  was  always  the  practice  of  the  inci- 
sionists.  The  final  abandonment  of  the  short 
incision  of  Hunter,  in  England,  after  a  few  years' 


428  MCDOWELL'S  OPERATLON 

trial  of  it,  and  the  return  there  to  the  long  in- 
cision of  McDowell,  may  be  considered  conclu- 
sive, it  is  thought,  not  only  as  to  the  originality 
of  the  procedure  of  the  latter,  but  as  to  the 
correctness  of  the  principles  upon  which  it 
rested. 

Mr.  Lizars  deserves  special  mention,  not 
only  on  account  of  his  being  the  fifth  surgeon 
to  employ  McDowell's  operation  of  ovariotomy 
by  the  long  incision,  and  of  the  results  he  se- 
cured from  the  procedure,  but  because  of  his 
unwarranted  neglect  for  seven  years  to  acknowl- 
edge his  accidental  possession  of  the  report  of 
McDowell's  first  three  cases  of  extirpation  of 
the  ovary.  His  first  case,  the  one  of  false 
diagnosis  and  unjustifiable  operation,  proved, 
of  course,  most  unfortunate  for  the  procedure, 
and  threw  a  damper  upon  it  in  the  estimation 
of  the  profession  in  Europe  for  many  years. 
His  second  case  (one  of  double  ovarian  dropsy), 
reported  as  being  successful,  was  unsatisfactory, 
to  say  the  least.  One  ovary,  it  is  true,  was 
removed,  but  the  woman  was  left  in  a  state  of 
continual  dread  of  having  to  go  through  with 
the  same  ordeal  for  removal  of  the  other,  and 
after  a  few  years  she  finally  died,  from  the  re- 
maining disease,  in  this  state  of  mind.     Double 


IN  GREA  T  BRITAIN.  429 

ovarian  disease  was  not  unknown  at  the  date  of 
this  operation  by  Mr.  Lizars,  though  the  facts 
show  that  this  was  the  first  time  that  tumors  of 
both  ovaries  had  been  encountered  in  an  opera- 
tion. As  brought  out  in  the  French  history, 
M.  Malaval,  in  the  early  part  of  the  last  cen- 
tury, found  in  an  autopsy  both  ovaries  to  be  the 
seats  of  tumors,  one  weighing  twelve  pounds 
and  the  other  fifteen  pounds.  Mr.  Lizars,  there- 
fore, acted  without  a  precedent,  and,  although 
wrongly,  did  the  best  he  knew  how  under  the 
circumstances.  He  could  have  removed  both 
ovaries  just  as  well,  with  but  little  increase  of 
risk,  and  it  was  the  proper  thing  to  have  done. 
The  case  has  an  additional  interest  in  beingf  the 
first  in  Great  Britain  to  recover  from  the  opera- 
tion of  extirpation  of  an  ovary,  and,  in  conse- 
quence of  this  fact,  aside  from  the  incomplete- 
ness of  the  result,  it  elicited  a  good  deal  of 
attention  there  from  the  profession.  It  is  said 
that  the  woman  (whether  at  the  instance  of  Mr. 
Lizars,  I  do  not  know)  came  from  Edinburgh  to 
London  on  a  visit,  and  was  there  the  subject  of 
several  examinations  by  prominent  physicians, 
notably  by  Prof.  Blundell,  the  greatest  advo- 
cate of  the  operation  that  had  been  performed, 
and  by  Dr.  James  Johnson,  the  greatest  critic 


430  MCDOWELL'S  OPERATION 

and  denouncer  of  it  at  that  date  of  its  trial. 
The  third  case  of  Mr.  Lizars  was  a  completed 
operation,  but  it  terminated  fatally  at  the  end  of 
fifty-three  hours.  In  his  fourth  case  the  opera- 
tion was  unfinished,  but  the  patient  recovered. 
These  three  operations  of  Mr.  Lizars,  affording 
the  occasion  of  his  second  paper,  were  all  per- 
formed within  two  months  (February  27,  Apri] 
24,  1825),  and  the  results  attending  them, 
together  with  that  of  his  previous  case  of  false 
diagnosis,  show  pretty  conclusively,  it  would 
seem,  why  he  cut  short  his  experience  in  this 
kind  of  surgery — an  experience  not  uncommon 
among  operators  in  like  cases  from  that  day 
down  to  the  present  time.  This  experience  of 
Mr.  Lizars  had  a  notable  precedent,  in  the  days 
of  incisionism,  in  the  operation  of  Delaporte, 
where,  after  opening  the  abdomen  and  the 
tumor,  and  thus  giving  vent  to  sixty-seven 
pounds  of  gelatinous  fluid  in  the  course  of 
eleven  days,  when  death  put  an  end  to  the 
scene,  he  wisely  suggested  that  instead  of  this 
kind  of  work,  it  would  be  preferable  "to  remove 
the  focus  of  the  disease,  namely,  the  tumor 
formed  by  the  ovary."  As  we  have  seen,  he 
even  advised  that  this  improved  operation 
should  be  performed  in  the  early  stage  of  the 


IN  GREA  T  BRITAIN.  43 1 

disease,  but  on  account  of  his  past  experience 
in  operating  he  does  not  appear  to  have  had 
any  desire,  himself,  to  engage  in  the  practice 
suggested,  and  here  ended,  it  seems,  his  mis- 
sion as  an  operator.  So  it  was  with  Mr.  Lizars. 
Such  is  the  experience  of  operators  still,  in  even 
less  grave  operations  than  those  referred  to, 
and  so  it  may  be  expected  to  continue  under 
like  circumstances  in  the  future. 

As  regards  the  conduct  of  Mr.  Lizars  toward 
Dr.  McDowell,  in  withholding  his  manuscript, 
sent  to  Mr.  Bell  for  publication,  for  seven  years 
without  acknowledgment,  and  then  publishing 
it  in  connection  with  a  case  of  false  diagnosis 
and  unjustified  operation,  there  is  nothing  that 
can  be  said  in  extenuation  of  such  neglect  of 
duty  and  injustice.  The  simple  statement  of 
the  facts  is  all  that  is  needed  here.  These 
carry  their  own  condemnation. 

As  to  the  unjust  criticisms  of  the  McDowell 
operation  and  the  retraction  of  the  same  by  Dr. 
Johnson,  they  speak  for  themselves,  as  we  have 
seen  in  connection  with  the  two  papers  of  Mr. 
Lizars  and  the  results  of  his  former  opera- 
tions. 

As  to  the  four  operations  following  Mr. 
Lizars's,  by    Dr.    Granville    and    Mr.   King,  in 


432  MCDOWELL'S  OPERATION 

which  the  long  incision  of  McDowell  was  em- 
•  ployed,  there  is  certainly  but  little  to  be  said 
further  than  that  they  proved  unsatisfactory : 
one  terminating  fatally,  and  three  being  left 
unfinished,  though  with  recovery.  The  two 
operations  of  Dr.  Granville  are  deserving  of 
note  as  being  the  first  performed  in  London, 
one  July  i,  1826,  and  the  other  early  in 
1827. 

In  connection  with  Mr.  King's  second  case, 
the  fact  is  worthy  of  special  mention  that  he  em- 
ployed in  the  after*treatment  large  doses  of 
opium  with  tincture  of  digitalis  and  cloths  over 
the  abdomen  wrung  out  of  cold  spring-water, 
and  finally  ice-water — an  addition  to  the  anti- 
phlogistic practice  then  in  vogue,  both  valuable 
and  creditable  to  his  judgment  as  a  surgeon. 

This  brings  us  to  the  case  of  Mr.  William 
Jeaffreson,  of  Framlingham,  who,  influenced  by 
the  case  of  Dr.  Nathan  Smith  in  the  United 
States,  as  we  have  seen,  was  the  first  to  revive 
and  make  trial  of  the  short  incision  in  the  lower 
division  of  the  abdomen,  as  proposed  by  Dr. 
William  Hunter  on  the  line  of  the  old  incision- 
ism.  The  idea  which  Mr.  Jeaffreson  had  in 
view  in  taking  up  this  old  method  of  incisionism 
was  precisely  the  same  that  influenced  the  old 


IN  GREA  T  BRITAIN.  43  3 

incisionists,  namely  :  to  operate  early,  when  the 
tumor  was  below  the  umbilicus,  and  situated 
more  or  less  on  one  side  or  the  other,  and  the 
quality  of  the  fluid,  as  determined  by  tapping, 
was  such  as  to  lead  to  the  conclusion  that  the 
tumor  was  simple  and  uncomplicated. 

In  the  study  and  investigation  of  this  class  of 
cases,  where  the  tumor  was  liable,  at  any  stage 
of  its  development  to  the  size  when  the  opera- 
tion was  called  for,  to  become  complicated  with 
pregnancy,  very  close  differentiation  between 
the  two  kinds  of  enlargement  became  neces- 
sary, and  thus  great  advance  had  already  been 
made  when  Mr.  Jeaffreson  came  to  recognize 
this  complication  in  a  case  of  the  kind  which  he 
afterward  operated  upon.  As  has  been  men- 
tioned, M.  Morand,  about  two-thirds  of  a  cen- 
tury previously,  had  called  attention  to  the 
possibility  of  such  a  complication  ;  citing,  as  he 
did  at  that  early  day,  a  case  in  which  it  occurred 
three  times,  little  or  no  inconvenience  being 
caused  until  the  third  time,  when  the  pregnancy 
failed  to  reach  full  term.  It  will  also  be  recalled 
that  a  case  complicated  with  pregnancy  came 
under  the  observation  of  Dr.  Ehrhartstein,  in 
Germany,  and  that  he  successfully  performed 

McDowell's  operation  just  after  labor  ;  a  trans- 

2s 


434  MCDOWELL'S  OPERATION 

lation  from  the  German  report  of  it  appearing 
in  the  Medico- Chirurgical  Review,  July,  1833, 
the  same  year  Mr.  Jeaffreson  encountered  his 
first  case.  The  latter  says  that  it  had  often 
occurred  to  him  that  the  operation  of  extirpa- 
tion of  a  dropsical  ovary  ought  to  be  attempted 
as  soon  as  the  tumor  began  to  distend  the 
abdominal  wall,  and  before  adhesions  had  taken 
place,  points  he  insisted  upon  as  being  a  sine 
qzia  non  to  success  ;  and  that  he  was  led  to 
these  conclusions  from  encountering  a  case  in 
which  the  tumor  proved  an  obstacle  to  the 
descent  of  the  child's  head  (1833).  The 
patient  died  a  few  days  afterward,  and,  learning 
from  the  autopsy  that  no  adhesions  existed,  he 
decided  upon  a  plan  of  removing  such  a  tumor 
by  operation,  as  previously  mentioned.  Mr. 
Jeaffreson,  it  would  seem  from  this,  was  familiar 
with  the  published  case  of  Dr.  Ehrhartstein,  and 
was  no  doubt  led  into  the  same  line  of  investi- 
gation thus  foreshadowed.  This  point,  I  think, 
is  made  clear  from  the  fact  that,  four  months 
after  the  publication  of  Dr.  Ehrhartstein's  case 
in  England  (November,  1833),  Mr.  Jeaffreson 
was  called  to  see  Mrs.  B.  in  her  second  labor, 
and  found  the  co-existence  of  a  small  dropsical 
ovary,   a    condition    of   things    similar    to    that 


IN  GREA  T  BRITAIN.  43  5 

found  in  the  case  previously  cited.  The  tumor 
was  pushed  up  out  of  the  way,  and  the  labor 
terminated  satisfactorily.  Again,  on  March  4, 
1836,  the  third  labor  occurred,  and  terminated 
in  a  satisfactory  way,  without  a  recurrence  of 
the  former  difficulty.  About  two  months  .later, 
the  patient  having  become  anxious  about  the 
size  the  tumor  had  attained,  and  having  been 
informed  of  the  danger  she  was  in,  decided  to 
submit  to  an  operation  for  its  removal,  which 
Mr.  Jeaffreson  performed  May  8,  1836.  The 
result,  as  we  have  seen,  proved  completely 
successful. 

From  these  circumstances  and  dates  it  is 
fair  to  infer  that  Mr.  Jeaffreson,  in  his  investi-. 
gation  regarding  the  relative  advantages  of  the 
short  incision  and  McDowell's  long  incision, 
profited  not  only  by  the  teachings  of  his  coun- 
tryman, Dr.  William  Hunter,  upon  this  point, 
but  by  the  previous  experience  of  Dr.  Nathan 
Smith  with  the  short  incision,  together  with 
that  of  Dr.  Ehrhartstein,  as  has  been  pointed 
out  in  relation  to  the  complication  of  ovarian 
■  dropsy  by  pregnancy.  When  he  made  an  in- 
cision midway  between  the  navel  and  the  pubes 
in  the  linea  alba  "between  ten  and  twelve 
lines  "  in    length   for  the  removal  of  a  tumor 


436  MCDOWELL'S  OPERATLON 

which  he  knew  to  be  small,  and  probably  with- 
out adhesions  (practical  information  derived 
from  nearly  three  years'  observation  of  its 
growth  and  behavior  through  two  pregnan- 
cies), he  had  only  to  seize  it  with  a  pair  of 
forceps,  puncture  a  cyst  or  two,  and  draw  it 
through  the  incision,  as  one  would  remove  a 
tent  from  a  sinus.  But  if,  contrary  to  expecta- 
tions, there  had  been  found  adhesions  of  the 
tumor  to  the  surrounding  parts,  he  would,  as  he 
takes  the  precaution  to  tell  us,  have  established 
communication  between  the  interior  of  the  cyst 
and  the  peritoneal  cavity,  thus  leaving  the  col- 
lapsed walls  of  the  former  to  take  care  of 
themselves  in  a  new  relationship.  This  is  an 
expedient  previously  suggested  by  Prof.  Blun- 
dell  in  connection  with  the  old  method  of 
incisionism.  How  different  was  the  prospect 
before  Dr.  Ehrhartstein  in  the  contingency  of 
his  meeting  with  such  a  complication  in  his 
case,  possessing,  as  he  did,  the  advantages 
afforded  by  the  long  incision  of  McDowell  for 
discovering  and  successfully  dealing  with  adhe- 
sions or  any  other  existing  complication.  And 
where  was  the  superiority  of  the  short  incision 
and  the  manipulation  of  the  tumor  employed 
by  Mr.  Jeaffreson,  over  the  practice  taught  him 


IN  GREA  T  BRITAIN. 


437 


seventy-four  years  previously  by  the  publication 

of  his  own  countryman,  Dr.  William  Hunter, 

in  the  following  words  ? 

"If  it  is  indeed  proposed  to  make  such  a  wound  in  the 
belly  as  will  admit  only  two  fingers  or  so,  and  then  to 
tap  the  bag  and  draw  it  out  so  as  to  bring  its  root  or 
peduncle  close  to  the  wound  of  the  belly,  that  the  surgeon 
may  cut  it  without  introducing  his  hand,  surely,  in  a  case 
otherwise  so  desperate,  it  might  be  advisable  to  do  it, 
could  we  beforehand  know  that  the  circumstances  would 
admit  of  such  treatment." 

The  favorable  circumstances  in  Mr.  Jeaffre- 
son's  case  were  the  previous  complications  of 
two  pregnancies,  and  a  fairly  thorough  under- 
standing, acquired  on  these  occasions,  of  the 
simple  and  even  the  uncomplicated  character 
of  the  "bag"  of  fluids  co-existing. 

But  even  in  a  case  so  simple  as  the  one 
described  by  Mr.  Jeaffreson,  where  the  cyst  can 
apparently  be  so  easily  removed  through  an 
opening  in  the  lower  division  of  the  abdomen, 
the  procedure  adopted  is  liable  to  be  followed 
by  serious  results,  as  we  learn  from  Mr.  Jeaffre- 
son himself.  On  the  fifth  day  after  the  opera- 
tion there  appeared  symptoms  of  very  grave 
and  threatening  import,  which  he  describes  in 
his  report  of  the  case  as  follows : 

"I  found  her  with  incessant  vomiting,  hiccough,  pulse 
scarcely   to   be    felt,   considerable    griping    pain    in    the 


438 


MCDOWELL'S  OPERATION 


bowels,  and  an  aching,  shooting  pain  along  the  course  of 
the  anterior  crural  nerve." 

Here  is  a  state  of  collapse  resulting  no  doubt 
from  injury,  and  perhaps  slow  hemorrhage. 
The  attending  peritonitis  was  held  in  check  and 
finally  controlled  by  large  doses  of  opium  with 
tincture  of  digitalis,  and  cloths  wrung  out  of 
ice-water  applied  continuously  over  the  abdo- 
men, as  had  been  employed  previously  and 
recommended  by  his  friend,  Mr.  King,  of  Sax- 
mundham.  To  this  treatment  was  largely  due, 
no  doubt,  the  final  good  result. 

Mr.  John  Gorham,1  some  four  years  after  the 
publication  of  Mr.  Jeaffreson's  case,  in  speaking 
of  excision  of  the  ovary  by  both  the  long  and 
short  incisions,  made  the  same  quotation  from 
the  publication  of  Dr.  William  Hunter  I  have 
given,  and  Mr.  Jeaffreson  took  exception  to 
this,  publishing  in  the  Lancet  a  communication 
in  which  occurs  the  following  statement : 

"  I  beg  to  say  that  I  was  perfectly  sincere  in  claiming  the 
more  simple  mode  of  operating  in  these  cases,  as  the  sug- 
gestion of  my  own  mind,  never  having  seen  or  heard  of 
Dr.  Hunter's  paper  on  the  subject.  Indeed,  I  think  it  is 
the  deference  which  has  heen  paid  to  the  gigantic  authority 
of  John  Hunter,  more  particularly  to  his  theory  of  '  Con- 

1  Lancet,  1839-40.,  vol.  i.,  p.  156. 


IN  GREA  T  BRITAIN. 


439 


tinuous  Sympathy,'  which  has  kept  abdominal  surgery  in 
comparative  abeyance. ' ' 

I  have  thus  given  more  attention  to  Mr. 
Jeaffreson's  case  of  extirpation  of  a  dropsical 
ovary  by  the  Hunterian  short  incision  than  I 
otherwise  would  have  done,  because  in  it  he 
claimed  originality  for  the  method,  just  as  was 
done  in  the  United  States  by  Dr.  Nathan  Smith 
and  his  supporters  ;  and  because  the  principles 
underlying  the  practice  deserve  here  to  be 
brought  out  anew  in  connection  with  the  trial 
of  the  latter  by  the  other  English  surgeons 
credited  with  cases  and  operations,  which  finally 
resulted  in  the  revival  of  the  long  incision  of 
McDowell. 

Mr.  King's  first  and  only  operation  by  the 
Hunterian  short  incision,  so  far  as  is  known, 
was  in  an  unmarried  woman,  aged  thirty-seven, 
and,  the  character  of  the  tumor  being  favorable 
for  it,  the  case  terminated  in  a  complete  cure 
under  the  employment  of  large  doses  of  opium, 
ice-water  to  the  abdomen,  and  in  the  rectum  as 
well,  with  tincture  of  digitalis  and  nutritive 
enemata. 

Mr.  West's  case,  in  which  the  tumor  had  also 
been  found  complicated  with  a  third  pregnancy, 
was  operated  upon  with  complete  success,  the 


44-0 


MCDOWELL'S  OPERATION 


operation  being  performed  and  the  after-treat- 
ment carried  out  in  conformity  with  the  rules 
laid  down  by  Messrs.  Jeaffreson  and  King.  His 
second  case  had  an  equally  favorable  ending. 
His  third  case,  Mrs.  Tompkins,  aged  forty,  had 
previously  been  tapped.  Hunterian  short  inci- 
sion employed,  as  usual.  Adhesions  found  and 
operation  abandoned.  Patient  tapped  seven- 
teen times  before  death  terminated  the  case. 
Who  can  say  that  the  long  incision  of  McDowell 
might  not  have  relieved  this  woman,  and  given 
her  an  additional  quarter  of  a  century  of  health 
and  happiness  ?  Mr.  West's  fourth  case  was 
similar  to  the  last,  the  Hunterian  short  incision 
being  used  with  a  like  abandonment  from  adhe- 
sions. Afterward  the  patient  was  tapped  re- 
peatedly. The  same  question  here  likewise 
applies. 

Mr.  Hargraves's  case,  aged  forty,  presented  a 
tumor  with  distinct  fluctuation,  but  solid  portions 
as  well  were  felt  through  the  walls  of  the  ab- 
domen. Hunterian  short  incision.  Adhesions 
found  and  the  operation  abandoned,  with  final 
■  recovery  of  patient.  This  case  was  wholly  un- 
suited  for  the  form  of  incision  employed.  The 
long  incision  of  McDowell  afforded  the  only 
chance  for  removal  with  certainty  and  safety ; 


IN  GREAT  BRITAIN.  44! 

and  why  was  it  not  tried  when  it  only  needed 
the  extension  of  the  short  incision  in  the  lower 
division  of  the  abdomen  into  the  region  above 
the  umbilicus  ? 

The  case  in  Guy's  Hospital,  the  first  operated 
upon  in  any  of  the  large  London  Hospitals, 
presented  a  fluctuating  tumor.  The  Hunterian 
short  incision  was  employed,  but  the  tumor 
could  not  be  reduced  in  size  and  drawn 
through  the  opening.  Operation  abandoned. 
Patient  died,  and  tumor  was  found  to  be 
multilocular,  with  but  slight  adhesions.  Here, 
who  could  say  that  the  long  incision  of 
McDowell  would  not  have  given  this  poor 
woman  the  requisite  chances  for  the  preser- 
vation of  her  life  ? 

Mr.  Crisp's  case  was  stated  to  be  of  twenty 
years'  standing,  and  she  had  been  tapped 
twice.  Hunterian  short  incision.  No  adhe- 
sions found,  cyst  punctured,  three  gallons  of 
fluid  drawn  off,  and  the  sac  removed  without 
difficulty.     Complete  cure. 

Mr.  Phillips's  case  was  a  young  woman.  The 
Hunterian  short  incision  employed.  No  adhe- 
sions found,  but  the  walls  of  the  cyst  said  to  be 
thick.  Cyst  punctured  and  drawn  through  the 
opening.      After    closure    of    the   wound    the 


442  MCDOWELL'S  OPERATLON 

patient  began  almost  immediately  to  complain 
of  pain  in  the  right  iliac  fossa.  On  the  third 
day  she  was  attacked  with  severe  diarrhoea,  and 
on  the  fifth  day  she  died.  Autopsy  showed 
ligature  on  pedicle  all  right,  but  eight  ounces  of 
blood  in  the  peritoneal  cavity.  Here  the  long 
incision  of  McDowell  would  have  permitted  an 
easy  exploration  and  removal  of  the  cyst,  and 
thus  have  prevented  the  injury  of  surround- 
ing structures,  the  cause,  no  doubt,  of  the 
hemorrhacre. 

In  these  ten  cases  operated  upon  by  the 
Hunterian  short  incision,  all,  of  course,  with  a 
view  to  the  more  or  less  simple  and  fluid  char- 
acter of  the  tumor,  the  latter  was  removed  in 
six  cases,  with  one  death,  and  was  not  removed 
in  four,  with  one  death  and  three  recoveries, 
the  latter  cases,  however,  all  terminating  fatally 
from  the  remaining  disease,  one  after  seventeen 
tappings,  another  after  repeated  tappings,  and 
the  last  after  a  period  not  long.  Thus  is  shown 
a  success  of  60  per  cent,  and  failures  in  40  per 
cent.,  with  a  mortality  of  20  per  cent.,  in  cases 
adjudged  suitable  for  the  operation,  and  all  by 
surgeons  of  recognized  high  ability. 

The  question  here  naturally  arose,  Why 
should  there  be  so  large  a  proportion  of  oper- 


IN  GREAT  BRITAIN.  443 

ations,  in  selected  cases,  unfinished  or  failures — ■ 
four  out  of  ten?  The  answer  was  that,  despite 
the  best  diagnosis  possible,  the  tumors  found  in 
the  four  unfinished  cases  proved  too  large  and 
too  much  complicated  by  adhesions  to  be  ex- 
amined, manipulated,  and  removed  through  the 
opening  in  the  lower  division  of  the  abdomen, 
then  deemed  sufficiently  large.  Dr.  Charles 
Clay,  in  England,  was  the  first  to  make  this 
answer,  and  to  rehabilitate,  so  to  speak,  the 
McDowell  long  incision,  made  in  both  the  lower 
and  upper  divisions  of  the  abdomen.  This  he 
did  in  a  case  operated  upon  successfully  Sep- 
tember 1 2,  1842,1  and  as  a  result  of  it  took  place 
the  so-called  revival  of  the  long-  incision  of  the 
"  Father  of  Ovariotomy,"  which  followed  a  year 
later  in  the  United  States,  in  the  hands  of  Dr. 
John  L.  Atlee,  and  soon  after  in  the  other  two 
countries,  France  and  Germany,  where  alike, 
as  we  have  seen,  his  operation  has  been  the 
subject  of  investigation  and  defence. 

Following  is  a  general  summary  of  cases 
and  results  in  the  United  States,  Germany, 
and  Great  Britain,  there  being-  no  case  of 
extirpation  of  a  diseased  ovary  in  France 
during  the  period  under  consideration. 

1  London  Medical  Gazette,  1842-43,  vol.  xxxi.,  p.  437. 


444 


MCDOWELL'S  OPERATION. 


General  Summary  of  Cases  and  Results  in  the 
United  States,  Germany,  and  Great  Britain. 

united    states. 

i  2  completed  operations,  with  9  cures  and  3  deaths. 
6  unfinished         "  "6  recoveries. 

Mortality  of  completed  operations,  25  per  cent. 

GERMANY. 

1 2  completed  operations,  with  5  cures  and  7  deaths. 
3  unfinished         "  "     1  recovery  and  2  " 

1  unjustified  operation,      "     1       " 

Mortality  of  completed  operations,  58.33  per  cent. 

GREAT    BRITAIN. 

9  completed  operations,  with  6  cures  and  3  deaths. 
8  unfinished         "  "7  recoveries  and  1  death. 

1  unjustified  operation,       "     1  recovery. 

Mortality  of  completed  operations,  33.33  per  cent. 


GRAND    TOTAL. 

33  completed  operations,  with  20  cures  and  13  deaths. 
17  unfinished         "  "     14  recoveries  and  3   " 

2  unjustified         "  "       2         " 

Mortality  of  completed  operations,  39.39  per  cent. 


CHAPTER   XV. 

EULOGISTIC    LETTERS,    ETC. 

3  Upper  Grosvenor  Street, 

London.  W.,  2d  July,  1887. 

Mrs.  Mary  Y.  Ridenbaugh: 

Dear  Madam  :  In  reply  to  your  letter  of  the 
10th  of  June,  I  may  say  that  I  shall  read  with 
great  interest  any  life  of  McDowell  that  you 
may  publish,  but  I  am  sorry  I  cannot  add  to 
what  I  have  said  about  him  in  my  book  on 
Diseases  of  the  Ovaries 

In  1878  I  delivered  six  lectures  at  our  Col- 
lege of  Surgeons,  and  I  concluded  those  lec- 
tures by  some  reference  to  McDowell. 

They  were  published  in  the  British  Medical 
Journal,  of  July,  1878  (p.  132),  and  as  you 
may  have  some  difficulty  in  finding  them  I 
enclose  the  remarks  which  I  then  made,  and 
which  I  can  still  entirely  confirm. 

I  am  sorry  I  cannot  be  of  any  further  assist- 
ance to  you.     I  remain,  my  dear  madam, 
Faithfully  yours, 

T.  Spencer  Wells. 

( 445 ) 


446  EULO  G  IS  TIC  LE  TTERS,  E  TC. 


The  Remarks  of  Sir  T.  Spencer  Wells.1 

The  hour  is  nearly  complete,  but  I  cannot  conclude 
the  very  hasty  and  imperfect  review  of  the  subject  of 
abdominal  tumors,  which  I  have  been  able  to  condense 
in  six  lectures — the  operation  now  accepted  as  the  only 
effectual  means  of  relief  in  cases  of  ovarian  tumors,  espe- 
cially— and  of  the  results  which  have  been  obtained  in 
alleviating  distress  and  prolonging  valuable  life,  without 
some  reference  to  the  man  who  is  justly  looked  upon  as 
"  the  father  of  ovariotomy. ' ' 

McDowell  was  wise,  practical,  and  prophetic.  He  care- 
fully studied  the  subject  which  filled  his  mind ;  did  with 
an  enviable  success  what  his  opportunities  permitted ;  and 
looked  with  an  anxious  eye  on  the  prospect  opening  up 
to  his  successors. 

We,  more  happy  in  our  opportunities,  have  entered  into 
full  possession  of  what  to  him  was  little  more  than  a 
promised  land ;  and,  speaking  personally,  I  feel  it  my 
greatest  happiness  to  have  been  able,  chiefly  through  the 
encouragement  of  professional  brethren  (which  at  one  time 
I  had  little  reason  to  anticipate),  to  reach  the  point  at 
which  McDowell  aimed. 

I  have  not  only  attained  the  amount  of  operative  suc- 
cess which  he  gave  as  the  standard ;  I  have  not  only  the 
almost  daily  gratification  of  seeing  some  living  and  endur- 
ing evidences  that  my  labors  have  not  been  in  vain  ;  but  I 
have,  for  the  rest  of  my  days,  the  satisfaction  of  knowing 
that  my  example  has  emboldened  others,  and  will  be  the 
means  of  still  further  extending  to  human  suffering  the  con- 
solatory assurance   of  the  prospect  of  relief,  and  insuring 

1  Delivered  at  the  close  of  a  series  of  six  lectures  on  the 
"Diagnosis  and  Surgical  Treatment  of  Abdominal  Tumors," 
at  the  Royal  College  of  Surgeons  of  England,  June  21,  1878. 


EULOGISTIC  LETTERS,  ETC.  447 

the  certainty  of  its  realization  by  the  many  skilful  hands 
which  are  now  betaking  themselves  to  the  work. 

This  is  a  lot  which  falls  to  but  few  innovators.  It  is  not 
given  to  every  one  to  see  the  fruit  of  his  labors;  but  the 
surest  way  of  gaining  that  end  is  by  studying  the  words 
and  following  the  counsel  of  wisdom.  The  wish  to  do 
well  what  others  have  done  is  not  all  that  is  wanted.  Step 
by  step  their  course  must  be  followed,  difficult  still,  but 
somewhat  easier  from  the  results  of  experience ;  and, 
while  I  content  myself  with  a  warning  to  aspirants  that  a 
fancied  inspiration  will  not  alone  carry  them  on  to  success, 
I  feel  that  I  cannot  quit  them  and  the  subject  better  than 
by  repeating  the  words  of  McDowell,  who,  though  better 
known  in  the  open,  rugged  field  of  practice  than  in  the 
paths  of  literature,  was  a  man  of  broad  and  elevated  views, 
and  thus  expressed  the  advanced  opinions  he  had  already 
formed  respecting  the  operation  he  had  inaugurated  after 
years  of  patient  waiting  and  zealous  preparation. 

He  strove  to  make  ovariotomy  a  boon  to  humanity.  He 
had  reason  to  believe  it  had  proved  so,  but  he  foresaw  the 
dangers  of  its  abuse  from  rash  and  indiscriminate  rivalry 
amongst  his  followers.  Listen  to  his  own  words:  "I 
think  my  description  of  the  mode  of  operating,  and  of  the 
anatomy  of  the  parts  concerned,  clear  enough  to  enable 
any  good  anatomist,  possessing  the  judgment  requisite  for 
a  surgeon,  to  operate  with  safety.  I  hope  no  operator  of 
any  other  description  may  ever  attempt  it.  It  is  my  most 
ardent  wish  that  this  operation  may  remain  to  the  mechan- 
ical surgeon  forever  incomprehensible.  Such  have  been 
the  bane  of  the  science ;  intruding  themselves  into  the 
ranks  of  the  profession  with  no  other  qualification  but 
boldness  in  undertaking ;  ignorant  of  their  responsibility, 
and  indifferent  to  the  lives  of  their  patients,  proceeding 
according  to  the  special  dictate  of  some  author  as  mechan- 
ical as  themselves,  they  cut  and  tear  with  fearless  in- 
difference, utterly  incapable  of  exercising  any  judgment 
of    their    own    in    cases '  of   emergency,    and    sometimes 


' 


44 8  EULOGISTIC  LETTERS,  ETC. 

without  possessing  even  the  slightest  knowledge  of  the 
anatomy  of  the  parts  concerned.  The  preposterous  and 
impious  attempts  of  such  pretenders  can  seldom  fail  to  prove 
destructive  to  the  patient  and  disgraceful  to  the  science. 
It  is  by  such  this  noble  science  has  been  degraded,  in  the 
minds  of  many,  to  the  rank  of  an  art." 

In  conclusion,  allow  me  to  read  a  sentence  or  two  from 
one  of  those  able  reviews  which  make  one  regret  that  the 
day  of  the  medical  quarterlies  is  passed  {British  and  Foreign 
Medical  Review,  April,  1873):  "All  honor  to  McDowell, 
of  Kentucky,  who,  to  use  the  words  of  Hufeland,  '  looked 
upon  his  profession  as  a  high  and  holy  office,  who  exercised 
it  purely,  not  for  his  own  advancement,  not  for  his  own 
honor,  but  for  the  glory  of  God  and  the  good  of  his  neigh- 
bor, and  who,  long  since  called  to  give  an  account  of  it, 
is,  no  doubt,  reaping  the  reward  of  his  faithful  steward- 
ship.'" 


EULOGISTIC  LETTERS,  ETC. 


449 


12  Granville  Place,  Portman  59,  W. 

Mrs.  M.  Y.  Ridenbaugh. 

Dear  Madam  :  I  beg  to  acknowledge  the 
receipt  of  your  valued  letter  of  the  12th  inst., 
asking  me  for  a  contribution  to  your  proposed 
work.  While  I  thank  you  for  the  compliment 
you  have  paid  me,  I  feel  that  anything  I  could 
say  would  only  burden  your  work,  and  could 
not  add  to  the  renown  attaching  to  the  name 
of  Ephraim  McDowell. 

I  shall  look  forward  with  much  anticipation 
to  the  reading  of  the  biography  of  so  remark- 
able a  man,  who  was  so  far  in  advance  of  his 
age,  whose  originality  and  surgical  skill  are 
still  so  conspicuous,  and  whose  name  is  insepar- 
ably linked  with  the  greatest  surgical  achieve- 
ment of  this  or  any  other  age. 

Hoping  that  a  grand  success  will  crown 
your  noble  efforts,  I  have  the  honor  to  be, 
dear  madam, 

Yours  very  faithfully, 

George  Granville  Bantock. 


29 


450  EULOGISTIC  LETTERS,  ETC. 

Correspondence   between    Professor   Alexander 

Russell  Simpson,  Dr.  Willoughby  Walling, 

and  the  Authoress, 

Relative  to  a  Lecture  delivered  by  Professor  Simpson  at  the 
University  of  Edinburgh,  Scotland,  October  19,  1887.1 

52  Queen  Street,  Edinburgh,  Scotland, 
October  20,  1887. 

Dr.  Willoughby  Walling. 

My  dear  Sir  :  My  introductory  lecture, 
which  contains,  I  believe,  everything  that  can 
be  gleaned  from  reference  to  our  University 
matriculation  books  regarding  Ephraim  Mc- 
Dowell, will  be  published  soon  in  one  of  our 
medical  journals,2  of  which  I  shall  be  glad  to 
send  a  copy  to  Mrs.  Ridenbaugh. 

Yours  very  faithfully, 

A.  R.  Simpson. 

The  above  note  was  in  reply  to  a  letter  to 
Professor  Simpson  from  Dr.  Willoughby  Wall- 
ing, United  States  Consul  for  Leith,  who  writes 
from  Edinburgh  to  the  authoress  of  this  work, 
as  follows  : 

1  Part  of  an  introductory  lecture  on  the  Ninth  International 
Medical  Congress  and  American  Gynecology. 

2  Published  in  the  British  Medical  Journal,  London,  July  2, 
1887,  vol.  ii.  p.  977. 


EULO  G  IS  TIC  LE  TTERS,  ETC.  45  j 

U.  S.  Consulate  for  Leith,  Edinburgh,  Oct.  20, 1887. 

Mrs.  Ridenbaugh. 

Dear  Madam  :  .  .  .  .  You  will  see  from 
the  enclosed  card  from  Professor  A.  R.  Simp- 
son that  I  am  in  a  way  to  get  what  you  want. 
I  will,  however,  be  compelled  to  wait  until  the 
publication  of  the  lecture  referred  to  in  the 
communication  of  Professor  Simpson. 

.....  I  want  to  suggest  that  if  you  have 
not  gotten  a  speech  made  by  Dr.  R.  O.  Cowl- 
ing,1 at  Danville,  Kentucky,  about  the  year  1879, 
at  the  meeting  of  the  Kentucky  State  Medical 
Society,  the  occasion  being  the  presentation  of 
the  door-knocker  of  Dr.  McDowell's  old  resi- 
dence to  Dr.  S.  D.  Gross,  of  Philadelphia,  you 
should  by  all  means  have  it. 

Dr.  Cowling  was  an  old  friend  of  mine,  a 
professor  of  surgery  in  the  University  of  Louis- 
ville, Ky.,  and  the  speech  referred  to  was  one  of 
the  most  eloquent  I  ever  heard,  and  was  equally 
laudatory  of  Dr.  McDowell  and  Dr.  Gross. 

So  strong  was  it  that  when  Dr.  Gross  arose 
to  reply  he  was  so  overcome  by  emotion  that 
he  could  not  speak  for  some  moments.  .  .  . 
Very  respectfully, 

WlLLOUGHBY    WaLLING. 
Seepage  553. 


452  EULO  GIS  TIC  LE  TTERS,  E  TC. 

52  Queen  St.,  Edinburgh,  Dec.  6th,  1887. 

Mrs.  Mary  Y.  Ridenbaugh. 

Dear  Madam  :  At  the  commencement  of  our 
session  I  gave  a  brief  sketch  of  the  work  of 
Dr.  Ephraim  McDowell.  .  .  . 

I  send  you  now  along  with  this  a  separate 
copy  of  the  lectures,  as  I  have  got  some  printed 
for  distribution  among  the  students.  .  .  . 

McDowell  was  a  hero  of  whom  our  profes- 
sion may  well  be  proud,  and  a  good  biography 
of  him  will  receive  a  wide  welcome.  .  .  . 

Believe  me, 

Yours  very  faithfully, 

A.  R.  Simpson. 


PROFESSOR  ALEXANDER    RUSSELL    SIMPSON'S 
LECTURE. 

I  have  said  that  the  Transactions  of  the  American 
Gynecological  Association  give  evidence  of  the  vast 
amount  of  earnest  and  faithful  work  that  is  wrought  in 
our  department  by  our  trans-Atlantic  confraternity.  And 
I  would  add  that  the  noble  services  they  have  rendered 
in  the  past  are  an  inspiration  and  incentive  to  them  and 
us  to  further  achievement  in  the  future. 

Have  you  ever  thought  how  much  obstetrics  and  gyne- 
cology owe  to  America  ?  ■  We  sometimes  hear  half  con- 
temptuous reference  to  the  scream  of  the  American  eagle ; 
but,  in  our  section  of  medicine,  at  least,  she  has  established 
the  strongest  claims  to  let  her  voice  be  heard. 


EULO  G  IS  TIC  LE  TTERS,  ETC.  .  c  3 

I  cannot  pretend  just  now  even  to  give  an  inventory 
of  the  contributions  that  have  travelled  to  us  over  the 
Atlantic  waters,  but  let  me  indicate  a  few. 

Laparotomy. — First  of  all,  we  must  acknowledge  Amer- 
ica's just  claim  to  be  the  birthplace  of  ovariotomy.  The 
conception  was  not  peculiarly  American.  It  had  been 
thought  of  elsewhere.  It  had  been  talked  of  and  written 
about,  but  only  to  be  talked  down  and  written  down.  It 
had  even  been  attempted,  but  usually  only  in  a  doubtful 
and  tentative  sort  of  way,  in  isolated  and  unsuccessful 
cases. 

In  1809,  at  Danville,  in  Kentucky,  a  practitioner  who 
had  already  achieved  a  surgical  reputation  for  success  in 
lithotomy  and  'hernia — numbering  among  his  thirty-two 
lithotomies  (all  successful)  an  operation  on  young  James 
K.  Polk,  who  afterward  became  President  of  the  United 
States — removed  an  ovarian  cystoma.  The  patient  recov- 
ered. Four  years  later  he  repeated  the  operation  on  an- 
other patient  with  successful  result.  After  the  lapse  of  two 
more  years  he  for  the  third  time  saved  a  life  by  extir- 
pating an  ovarian  tumor. 

He  did  not  publish  his  cases  Until  181 7,  and  then  in  a 
somewhat  slipshod  fashion  in  an  American  journal.  He 
sent  a  copy  of  his  paper  to  his  old  teacher,  John  Bell,  of 
Edinburgh.  John  Bell  was  ill  at  the  time,  and  away  on 
on  the  Continent  in  quest  of  health.  The  paper  fell  into 
the  hands  of  John  Lizars,  who  was  doing  duty  in  the  ab- 
sence of  his  friend.  Stimulated  by  the  perusal,  Lizars 
opened  an  abdomen  where  he  and  some  of  the  other 
Edinburgh  surgeons  and  obstetricians  believed  the  pa- 
tient to  be  the  subject  of  an  ovarian  tumor. 

He  seems  to  have  supposed  that  the  American's  success 
was  in  some  measure  due  to  climatic  conditions,  from  this 
sentence,  "As  inflammation  appears  to  be  generally  in- 
duced by  exposure  to  cold,  and,  as  these  cases  succeeded 
so  well  in  America,  I  desired  the  room  to  be  heated  to 
8o°   F."     The  diagnosis  proved    to    be   wrong,   but   the 


454  EULO  G IS TIC  LE  TTERS,  E  TC. 

patient  recovered,  and  Lizars  republished  in  the  Edinburgh 
Medical  Journal,  for  October,  1824,  the  cases  of  the  more- 
successful  American  surgeon,  prefixing  a  brief  historical 
notice  of  the  operation,  and  appending  the  history  of  his 
own  case. 

How  this  first  public  announcement  of  the  splendid 
achievement  was  received  in  England  let  the  editor  of  the 
London  Medico- Chirurgical  Review,  writing  a  notice  of 
Mr.  Lizars's  paper,  reveal  to  us : 

"  Passing  over  the  records  of  surgery,  all  of  which  can- 
not be  depended  on,  we  shall  come  at  once  to  the  recent 
facts,  or  alleged  facts,  communicated  in  this  paper  by  Mr. 
Lizars.  Three  cases  of  ovarian  extirpation  occurred,  it 
would  seem,  some  years  ago  in  the  practice  of  Dr.  Mac- 
dowal,  of  Kentucky,  which  were  transmitted  to  the  late 
John  Bell,  and  fell  into  the  hands  of  Mr.  Lizars.  We 
candidly  confess  that  we  are  rather  sceptical  respecting 
these  statements,  and  we  are  rather  surprised  that  Mr. 
Lizars  himself  should  put  implicit  confidence  in  them.  A 
woman,  supposed  to  be  parturient,  was  visited  by  Dr. 
Macdowal  at  the  instigation  of  two  physicians  who  con- 
sidered her  in'  the  last  stage  of  pregnancy.  Dr.  Macdowal 
found  the  uterus  unimpregnated,  but  a  large  tumor  in  the 
abdomen  movable  from  side  to  side.  The  woman  travelled 
sixty  miles  on  horseback  to  have  an  operation  performed. 
Dr.  Mac  made  an  incision,  nine  inches  in  length,  parallel 
with  the  rectus  abdominis,  and  right  into  the  abdominal 
cavity.  The  tumor  appeared  in  view,  but  could  not  be 
removed.  A  ligature  was  thrown  round  the  Fallopian 
tube,  the  tumor  cut  open  (found  to  be  the  ovarium)  and 
fifteen  pints  of  dirty  gelatinous  stuff  extracted,  'after 
which  we  cut  through  the  Fallopian  tube  and  extracted  the 
sac,  which  weighed  seven  pounds  and  a  half.'  As  soon  as 
the  external  opening  was  made  the  intestines  rushed  out 
upon  the  table,  and  they  could  not  be  replaced  till  after 
the  operation  was  performed,  which  lasted  twenty-five 
minutes  1     The  wound  was  sewed  up  by  means  of  the  inter- 


EULO GIS TIC  LE TTERS,  ETC.  455 

rupted  suture,  assisted  by  means  of  adhesive  plaster.  Dr. 
Mac  visited  the  patient  at  the  end  of  five  days,  though  she 
had  come  to  his  own  residence  to  have  the  operation  per- 
formed !  !  He  found  her  engaged  in  making  her  bed  ! 
She  soon  returned  to  her  native  place  quite  well.  Credat 
Judozus,  non  ego. 

"  The  second  case  is  little  less  extraordinary,  if  not 
incredible.  A  negress  had  a  hard,  painful,  fixed  tumor  in 
the  abdomen.  Dr.  Mac  placed  her  on  a  table,  laid  the 
abdomen  open,  inserted  his  hand,  and  found  the  ovaria 
very  much  enlarged,  painful  to  the  touch,  and  firmly  ad- 
hering to  the  bladder  and  fundus  uteri.  To  extract  this 
(two  ovaria)  he  thought  would  be  instantly  fatal ;  '  but, 
by  way  of  experiment,'  says  the  doctor,  'I  plunged  the 
scalpel  into  the  diseased  part,  when  some  gelatinous  sub- 
stance, as  in  the  above  case,  with  a  profusion  of  blood, 
rushed  to  the  external  opening,  which  I  conveyed  off  by 
placing  my  hand  under  the  tumor  and  suffering  the  dis- 
charge to  run  over  it.'  A  quart  or  more  of  blood  escaped 
into  the  abdomen.  The  same  dressing  and  the  same, 
success  as  in  the  first  case.  We  cannot  bring  ourselves  to 
credit  this  statement." 

The  same  Review  writer  in  April,  1825,  has  still,  no 
doubt,  the  Kentucky  operator  (McDowell)  in  his  mind 
when  he  falls  foul  of  the  great  obstetrician,  Dr.  Blundell, 
for  thinking  that  ovariotomy  will  ultimately  come  into 
general  use,  and  saying:  "If  the  British  surgeons  will 
not  patronize  and  perform  it,  the  French  and  American 
surgeons  will;"  for  he  adds:  "In  despite  of  all  that 
has  been  written  respecting  this  cruel  operation  we  entirely 
disbelieve  that  it  has  ever  been  performed  with  success — 
nor  do  we  think  it  ever  will." 

How  hard  it  is  to  move  a  man  who  has  committed  him- 
self to  the  position  of  a  sceptic  may  be  seen  from  the 
manner  in  which  this  writer  returns  to  the  subject  in  Octo- 
ber, 1826,  after  the  North  American  Medical  and  Surgi- 
calJournal 'had  come  into  his  office  to  tell  him  that  "Dr. 
Mac,"  as  he  contemptuously  called  the  ovariotomist,  had 


456  .     EULOGISTIC  LETTERS,  ETC. 

operated   not  only  three  but  five   times,   and  in.  four  of 
the  cases  with  success. 

"  Extirpation  of  an  Ovarium. — A  back  settlement  of 
America — Kentucky — has  beaten  the  mother  country,  nay, 
Europe  itself,  with  all  the  boasted  surgeons  thereof,  in  the 
fearful  and  formidable  operation  of  gastrotomy,  with  ex- 
traction of  diseased  ovaria.  In  the  second  volume  of  this 
series,  page  216,  we  adverted  to  the  cases  of  Dr.  Macdowal, 
of  Kentucky,  published  by  Mr.  Lizars,  of  Edinburgh,  and 
expressed  ourselves  as  sceptical  respecting  their  authen- 
ticity. Dr.  Coates,  however,  has  now  given  us  much  more 
cause  for  wonder  at  the  success  of  Dr.  Macdowal ;  for  it 
appears  that  out  of  five  cases  operated  on  in  Kentucky  by 
Dr.  M.,  four  recovered  after  the  extraction,  and  only  one 
died.  There  were  circumstances  in  the  narratives  of  some 
of  the  first  three  cases  that  raised  misgivings  in  our  minds, 
for  which  uncharitableness  we  ask  pardon  of  God,  and  of 
Dr.  Macdowal,  of  Danville.  The  two  additional  cases 
now  republished  (for  it  appears  that  the  cases  were  pub- 
lished, though  in  a  very  unsatisfactory  form,  in  the  Ameri- 
can Eclectic  Repertory^  are  equally  wonderful  as  those 
with  which  our  readers  are  already  acquainted."  And 
toward  the  close  of  the  article  he  says:  "  It  was  this  mode 
of  narration  that  excited  our  scepticism,  and  we  must  con- 
fess it  is  not  yet  removed." 

Now  the  man  whose  splendid  success  in  a  new  field  was 
received  with  so  much  scorn  and  scepticism,  not  only  on 
this  side  of  the  ocean  but  his  own,  was  no  haphazard 
adventurer  out  in  the  wild  West. 

Born  in  Virginia  in  1771,  and  moved  with  his  father's 
household  to  Kentucky  in  1782,  where  his  father  became 
judge  of  the  district  court,  he  seems  to  have  had  but 
an  imperfect  training  in  letters  in  a  land  that,  during  his 
childhood,  was  fighting  its  way  to  freedom.  After  leaving 
school  he  studied  medicine  with  Dr.  Humphreys,  of  Staun- 
ton, Virginia,  a  graduate  of  the  University  of  Edinburgh. 
Philadelphia  was  then  the  only  seat  of  medical  education 
in  the  United  States,  and  doubtless  it  was  at  the  instance 


EULOGISTIC  LETTERS,  ETC. 


457 


of  this  Edinburgh  alumnus,  with  whom  he  had  been  read- 
ing from  two  to  three  years,  that  the  eager  student  crossed 
the  deep,  and  came  to  enroll  himself  among  the  Cives 
Academic  Edinensis. 

In  the  roll  of  Session  1792-93  I  find  that  Ephraim  Mc- 
Dowell has  inscribed  his  name  as  it  is  reproduced  in  the 
zincotype  (see  frontispiece).  It  was  not  then  the  custom 
for  the  entrant  to  give  his  place  of  birth  and  residence. 
So  he  has  simply  signed  his  name,  and  opposite  the  sig- 
nature the  secretary  has  noted  that  he  is  entered  to  study 
chemistry. 

In  that  subject  he  would  come  under  the  inspiring  in- 
fluence of  Joseph  Black,  and,  as  he  had  no  other  university 
class  that  session,  it  was  probably  during  it  that  he  studied 
surgery  with  John  Bell.  In  a  biographical  sketch  of  him 
by  the  late  Professor  Gross,  of  Philadelphia,  it  is  stated  very 
confidently  that  it  was  during  his  second  year  that  he 
attended  the  lectures  of  that  distinguished  extra-mural 
teacher.  But,  when  he  matriculates  for  the  second  time, 
at  the  beginning  of  session  1793-94,  he  is  entered  for  the 
classes  of  anatomy  and  surgery  under  the  second  Monro; 
practice  of  medicine  under  James  Gregory ;  and  botany 
under  Daniel  Rutherford ;  besides  the  clinical  prelections 
in  the  Royal  Infirmary. 

With  so  much  to  do  in  his  second  session,  and  so  little 
in  the  first  within  the  university,  it  seems  to  me  more 
probable  that  he  had  put  himself  under  Bell's  tuition  dur- 
ing his  first  session  here. 

Our  librarian  has  shown  me  the  library  day-book  of  the 
time,  from  which  it  appears  that  throughout  he  had  been 
greatly  interested  in  the  study  of  chemistry.  On  February 
25,  1793,  he  had  out  Hopson's  Chemistry  ;  on  March  nth, 
Hoffman's  Practice  of  Medicine ;  March  25th,  Chaptal's 
Chemistry;  April  8th,  vol.  ii.  of  the  same  work,  and  on 
April  27th,  Hamilton  on  Female  Complaints. 

During  the  summer  he  had  ceased  to  borrow  from  the 
library,  and  he  then  may  have  been  making  the  excursion 
through  Scotland,  described  by  Gross,  in  company  with 


458  EULO  G IS  TIC  LE  TTERS,  E  TC. 

two  of  his  compatriots,  one  of  whom  had  been  his  fellow* 
apprentice  with  Dr.  Humphrys,  of  Staunton,  and  who 
enrolled  himself  in  the  same  two  sessions  with  McDowell 
as  Sam  Brown. 

On  September  25th  a  friend,  James  Cairns,  a  matriculate 
of  1793-94,  gets  Fourcroy's  Chemistry  for. him ;  on  Octo- 
ber 3d  he  is  at  the  library  himself  for  Savary's  Letters  on 
Egypt ;  on  October  15  th  he  gets  a  volume  of  Chemical 
Theses  and  two  volumes  of  Medical  Commentaries ,  and  the 
last  entry  is  on  October  29th,  1793,  when  his  friend  Cairns 
gets  for  him  Cullen's  Practice  of  Physic. 

Among  the  readers  who  must  have  rubbed  shoulders  with 
him  at  the  librarian's  table  were  Henry  Brougham  and 
Francis  Horner ;  among  the  students  who  sat  in  the  same 
classes  with  him  were  Monro  Tertius,  (Sir)  William  New- 
bigging,  and  John  Bell's  youngest  brother,  (Sir)  Charles. 

Members  of  the  athletic  club  will  be  pleased  to  hear,  from 
Dr.  Gross,  that  he  used  often  to  narrate  with  special  glee 
how,  during  his  sojourn  in  Edinburgh,  "a  celebrated  Irish 
foot-racer  arrived,  boasting  that  he  could  outrun,  outhop, 
and  outjump  any  man  in  the  city,  and  bantered  the  whole 
medical  class.  McDowell  was  selected  as  their  champion. 
The  distance  was  sixty  yards,  and  the  stake  ten  guineas. 
The  trial  took  place  in  the  college  grounds,  and  the  Amer- 
ican allowed  himself  purposely  to  be  the  loser.  A  second 
race  for  one  hundred  guineas  and  at  an  increased  distance 
came  off  soon  afterward,  and  this  time  the  Irishman,  after 
much  bullying,  was  badly  beaten,  much  to  his  own  chagrin 
and  the  gratification  of  the  students."  That  by  way  of 
parenthesis  to  help  you  know  the  man. 

Gross  is  uncertain  as  to  whether  he  graduated  here  or  not. 
But  clearly  he  had  not  taken  out  the  requisite  courses  to 
qualify,  and  his  name  is  not  to  be  found  in  our  roll  of 
graduates. 

Doubtless  his  biographer  is  correct  in  thinking  that  the 
teacher  from  whom  he  learned  the  most  was  John  Bell, 
whose  "enthusiasm  and -ardor,"  says  Gross,  "were  abso- 
lutely boundless." 


EULO GIS TIC  LE TTERS,  ETC.  459 

It  is  difficult  to  conceive,  at  this  distant  day,  the  charm 
which  this  great  teacher  infused  into  his  subjects  and 
the  ambition  which  he  inspired  in  his  pupils.  All  loved 
him;  many  worshipped  him;  not  a  few  idolized  him. 
Among  the  latter  was  the  subject  of  this  memoir. 

During  his  attendance  upon  his  prelections  the  young 
American  was  enraptured  by  the  eloquence  of  his  teacher, 
and  the  lessons  which  he  imbibed,  while  thus  occupied,  were 
not  lost  upon  him  after  his  return  to  his  native  country. 

Mr.  Bell  is  said  to  have  dwelt  with  peculiar  force  and 
pathos  upon  the  organic  diseases  of  the  ovaries,  speaking 
of  their  hopeless  character,  when  left  to  themselves,  and  of 
the  possibility,  nay  practicability,  of  removing  them  by 
operation.  The  instruction  thus  given  made  a  powerful 
impression  upon  Dr.  McDowell,  which  was  not  lost  upon 
him  after  he  took  leave  of  the  academic  groves  of  Edin- 
burgh. 

What  actual  success  McDowell  on  the  whole  achieved  is 
not  accurately  known.  It  is  said  he  operated  thirteen 
times  in  all  with  eight  recoveries.  It  would  seem,  there- 
fore, that  he  was  not  so  happy  in  his  later  series  of  cases  as 
he  had  been  in  his  earlier.  But,  it  was  a  splendid  triumph, 
then,  to  have  rescued  eight  women  from  inevitable  death, 
and,  whatever  premonitions  of  it  there  may  have  been 
beforehand,  America  has  the  right  to  claim  for  Ephraim 
McDowell  the  foremost  place  among  ovariotomists. 

As  Prof.  Parvin  said  :  "  The  suggestions  of  Hunter  and 
the  instructions  of  Bell  had  an  important  influence  upon 
McDowell's  mind,  but  this  detracts  nothing  from  the  glory 
of  his  achievement.  The  fame  of  Columbus  is  not  dimmed 
by  the  fact  that  others  before  him,  others  in  his  time,  be- 
lieved with  him  that  by  sailing  westward  a  sea-way  to  the 
Indies  would  be  found.  No  matter  what  surgeons  may  have 
believed  and  suggested  as  to  removal  of  diseased  ovaries, 
no  matter  though  John  Bell  taught  the  mode  of  operating, 
their  faith  without  works  was  utterly  dead,  and  the  new 
Columbus  (McDowell)  started  upon  his  exploration  without 
pilot  or  chart. ' ' 


460  EULOGISTIC  LETTERS,  ETC. 


Response  of  Professor  D.  W.  Yandell, 
of  Louisville,  Ky., 

In  behalf  of  the  invited  guests,  at  a  Complimentary  Dinner  to 
Professor  Samuel  D.  Gross.1 

Mr.  Chairman  :  When  the  invitation  came  to  unite  in 
this  offering,  I  was  deeply  touched.  It  revived  memories 
of  my  student  life,  when,  as  a  pupil  of  your  guest,  I  came 
before  him  for  examination  for  the  doctorate,  now  thirty- 
three  years — a  generation — ago.  The  teachings  of  that 
period  have  remained  a  part  of  my  life.  The  method, 
the  system,  which  the  great  master  observed,  as  in  his 
earnest  way  he  gradually  unfolded  to  the  minds  of  his 
hearers  the  grand  truths  which  lie  in  the  upper  planes  of 
surgery ;  the  painstaking,  conscientious  care  with  which  he 
infused  interest  into  the  dry  details  of  his  subject,  his  fiery 
zeal,  his  never-flagging  industry,  and,  better  than  all  this, 
the  solemnity  with  which  he  declared  that  to  be  a  truly  great 
physician  it  was  essential  to  be  at  the  same  time  a  truly 
good  man — all  these  are  as  fresh  to  me  this  evening  as 
when  I  made  one  of  his  hearers,  now  so  long  ago. 

Mr.  Chairman,  I  obeyed  the  summons  to  be  here  with 
alacrity.  I  came  with  pleasure.  Nay,  more,  I  came  with 
feelings  akin,  I  fancy,  to  those  which  animate  the  pilgrim 
as  he  turns  his  footsteps  toward  the  tomb  of  the  Prophet. 

With  fitting  reverence,  sir,  I  stand  in  this  august  pres- 
ence. I  come,  sir,  as  the  humble  representative  of  a  great 
people,  the  people  of  Kentucky,  who  send  you  greeting 
on  this  auspicious  occasion.  I  come,  empowered  by  them 
to  lay  at  the  feet  of  your  illustrious  guest  the  homage  of 
that  renowned  commonwealth.  I  come  to  wish  him  yet 
many  years  upon  the  earth,  and  to  say  that,  though  his 
name  and  fame  have   become  a  common  heritage,  Ken- 

1  Given  by  his  medical  friends  in  commemoration  of  his 
fifty-first  year  in  the  profession.  April  10,  1879. 


EULO  GIS  TIC  LE  TTERS,  E  TC.  46  j 

tucky  still  claims  them  as  peculiarly  her  own,  since  it  was 
in  her  borders  that  he  laid  the  foundation  of  a  reputation 
which  has  not  only  irradiated  this  continent,  but  has 
penetrated  wherever  civilization  is  known  or  surgery  is  cul- 
tivated as  a  science. 

I  feel,  Mr.  Chairman,  that  it  is  an  honor  to  be  called  on 
to  speak  on  such  an  occasion  and  for  such  a  people — a 
people  that  has  given  to  statesmanship  a  Clay,  a  Lincoln, 
and  a  Breckenridge  ;  to  arms  a  Johnston,  a  Preston,  and 
a  Buckner ;  and  to  surgery  a  McDowell  and  a  Dudley.  A 
goodly  company!  Stately  names!  Would  you  think  me 
as  exceeding  the  limits  of  good  taste  if  I  added — and 
chief  among  all  these  is  that  of  him  who  bears  the  mark 
of  our  guild — Ephraim  McDowell  ? 

For,  sir,  will  not  the  labors  of  the  statesman  yield  to 
the  pitiless  logic  of  events ;  the  voice  of  the  orator  grow 
fainter  in  the  coming  ages ;  and  the  deeds  of  the  soldier 
eventually  find  place  but  in  the  libraries  of  the  student  of 
military  campaigns ;  while  the  achievements  of  the  village 
surgeon  (McDowell)  like  the  widening  waves  of  the  inviolate 
sea,  shall  reach  the  uttermost  shores  of  time,  hailed  of  all 
civilizations  as  having  lessened  the  sufferings  and  length- 
ened the  span  of  human  life  ? 

Again,  would  you  think  me  very  far  wrong  were  I  to 
couple  the  victorious  issue  of  the  late  war,  and  the  opera- 
tion of  ovariotomy  as,  in  different  fields,  the  two  most 
stupendous  events  of  modern  times  ? 

Sir,  both  are  to  be  credited  to  Kentuckians.  Mr.  Lin- 
coln effected  the  one.  '  Dr.  Ephraim  McDowell  accom- 
plished the  other. 

Nor  yet,  in  my  opinion,  do  the  two  achievements  admit 
of  comparison.  Powerful  cabinets,  far-seeing  ministers, 
renowned  captains,  a  daring  and  multitudinous  soldiery,  a 
rich,  a  steady,  a  united,  and  a  persistent  people  contributed 
to  the  success  of  the  former.  Its  glory  was  won  amid  the 
blare  of  trumpets,  the  groans  of  men,  the  shock  of  contend- 
ing armies.     The  glory  of  the  other  belongs  to  but  one 


462  EULOGISTIC  LETTERS,  ETC. 

man,  is  single  and  indivisible,  was  born  under  the  eyes  of 
fair  women,  and  by  the  cunning  of  a  single  hand,  which, 
amid  supreme  peril,  plucked  victory  from  an  enemy  that, 
before  McDowell's  time,  had  defied  all  that  was  subtlest  in 
art,  and  repulsed  every  assault  of  science. 

But,  sir,  I  fain  must  have  done.  I  feel  that  it  is  good  to 
have  been  here.  I  shall  return  to  my  people  and  recount 
to  them  what  I  have  seen  and  what  heard,  and  repeat  to 
them  what  I  now  offer  in  their  name  : 

"To  our  guest,  the  illustrious  son  of  Pennsylvania,  the 
foster  son  of  Kentucky,  who,  to  the  nimbus  which  ever 
encircles  great  deeds,  has  added  the  milk-white  flower  of  a 
stainless  life." 


EULOGISTIC  LETTERS,  ETC.  463 

St.  Louis,  Mo.,  May,  1889. 

Mrs  Mary  Y.  Ridenbaugh. 

My  dear  Madam:  I  regret  very  much  that 
unavoidable  circumstances  prevented  me  from 
calling  upon  you  personally  before  you  left  the 
city,  thus  enabling  me  to  form  a  more  correct 
idea  of  the  scope  of  the  memoir  which  you  are 
preparing  of  your  distinguished  ancestor,  Dr. 
Ephraim  McDowell. 

You  request  me  to  make  some  contribution 
to  your  work,  forgetting,  perhaps,  that  not 
knowing  what  others  have  written,  I  may  follow 
too  nearly  in  their  footsteps  to  present  anything 
worthy  of  being  considered  original  or  readable. 

For,  I  feel  that  I  would  be  unable  to  add  a 
single  leaf  to  the  garland  of  honor  and  glory 
which  an  enlightened  and  grateful  profession 
have  already  woven  around  the  name  and 
memory  of  your  distinguished  grandfather. 

So  long  as  the  fame  of  Sir  Isaac  Newton  is 
cherished  among  philosophers,  or  that  of  Chris- 
topher Columbus  is  held  in  reverence  by  navi- 
gators, will  the  lesson  of  the  life  and  achieve- 
ments of  McDowell  receive  respectful  homage 
at  the.  hands  of  surgeons  throughout  the  entire 
world.     And  could  the  women  of  the  present 


464  EULO  G  IS  TIC  IETTERS,  E  TC. 

generation  fully  realize  the  blessings  which  have 
accrued  to  their  sex  through  the  seeds  planted 
by  the  patient  industry  of  this  great  physician, 
they  would  erect  above  his  grave  a  monument 
far  eclipsing  the  proudest  of  the  Pyramids. 

But,  it  is  not  in  the  line  of  eulogy  that  I  would 
speak  of  Dr.  Ephraim  McDowell,  for  he  needs 
none. 

The  practical  lesson  of  his  professional  life  is 
to  me  the  chief  object  of  interest  and  study, 
since  it  carries  with  it  a  moral  of  peculiar  value 
to  the  younger  members  of  the  medical  profes- 
sion. Although  he  had  the  best  advantages 
of  study  which  his  times  and  generation  afforded, 
yet  his  sources  of  information  were  limited  as 
compared  with  the  superior  resources  accessible 
to  the  student  of  the  present  day. 

He  evidently  possessed,  however,  a  well- 
trained  and  analytical  mind  which  enabled  him 
to  turn  to  the  best  account  such  opportunities 
as  came  in  his  way.  He  cultivated  inde- 
pendence of  thought  and  action.  What  he 
learned  he  learned  well ;  so  well,  that  it  proved 
a  deep  and  abiding  foundation  upon  which  he 
could  venture  to  build.  To  a  natural  courage 
was  added  that  self-reliance  which  is  born  of 
mature  knowledge  and  clear  perception.      He 


EULO  GIS  TIC  L  E  TTERS,  E  TC.  46  5 

was  evidently  a  close  and  practical  student  of 
those  fundamental  principles  of  medicine,  anat- 
omy, physiology,  and  pathology.  The  surgical 
triumph  which  in  due  time  rendered  his  name 
famous  followed  naturally. 

Galileo  was  not  the  first  to  suggest  the  tele- 
scope, neither  was  McDowell  the  first  to  sug- 
gest ovariotomy,  and  yet  "their  names  will  be 
handed  down  to  future  ages  as  indissolubly 
connected  with  two  of  the  crowning  triumphs 
of  science.  What  the  one  did  for  astronomy 
the  other  accomplished  for  abdominal  surgery. 
Each  developed  and  crystallized  into  practical 
results  what  before  were  merely  theories,  or 
vague  ideas. 

It  is  difficult  for  the  layman,  who  is  ignorant 
of  the  anatomical  relations  and  pathological 
conditions  peculiar  to  the  several  varieties  of 
ovarian  tumors,  to  fully  appreciate  the  brill- 
iancy of  McDowell's  achievement.  It  is  only 
the  anatomist  and  the  pathologist  who,  in  the 
light  of  knowledge,  can  enter  fully  into  the 
spirit  which  animated  this  bold  pioneer  as  he 
ventured  into  a  hitherto  unexplored  region  ol 
surgery,  with  rude  instruments  and  with  no 
precedents  to  guide  him. 

It  is  plain   that   he  had   pondered  well  over 


466 


EULOGISTIC  LETTERS,  ETC. 


the  prophetic  suggestions  of  the  great  Hunter, 
and  of  his  illustrious  preceptor,  John  Bell,  of 
Edinburgh.  In  this  instance  Hunter  may  have 
planted,  and  Bell  watered,  but  it  was  McDowell 
whose  intelligent  and  unerring  hand  plucked 
the  practical  fruit  of  victory. 

After  careful  dissections  and  patient  investi- 
gation at  the  bed-side  and  in  the  dead  house, 
he  arrived  at  a  matured  and  intelligent  plan  of 
procedure,  which  for  the  first  time  placed  the 
operation  of  ovariotomy  upon  a  scientific  basis. 

However  brilliant  may  have  been  the  im- 
provements which  have  attended  later  efforts 
in  this  direction,  it  will  be  impossible  to  efface 
the  debt  of  oratitude  due  to  the  courage  and 
skill  manifested  in  the  conception  and  execution 
of  Ephraim  McDowell. 

Trusting  that  you  may  meet  with  success  in 

your   very    laudable    undertaking    I    am,    with 

respect, 

Very  truly  yours, 

Walter  Coles,   M.D. 


McDowell    Monument.  Danville.  Kentucky. 
Erected  in  1S79. 


COPYRIGHTED     1879   BY  E   H    FOX 


CHAPTER    XVI. 

MEMORIAL   SERVICES   AT   THE    UNVEILING    OF 

the  Mcdowell  monument. 

This  chapter  is  made  up  from  a  volume  en- 
titled "Memorial  Oration  in  Honor  of  Ephraim 
McDowell,  the  'Father  of  Ovariotomy,'"  pub- 
lished by  the  Kentucky  State  Medical  Society, 
Louisville,   1879. 

That  Dr.  Ephraim  McDowell,  of  Danville, 
Ky.,  was  the  first  to  perform  the  operation  of 
ovariotomy,  and  by  his  successful  cases  make 
the  extirpation  of  diseased  ovaria  a  legitimate 
surgical  procedure,  has  long  been  conceded 
both  in  this  country  and  in  Europe.  To  Dr. 
S.  D.  Gross,  of  Philadelphia,  is  due  the  credit 
of  successfully  establishing  the  claims  of  Mc- 
Dowell to  priority  in  this  important  field  of 
surgery. 

The  idea  of  marking  the  last  resting-place  of 
the  first  ovariotomist  with  some  memorial  com- 
memorative of  his  great  services  to  humanity 
originated  with  the  late  Dr.  John  D.  Jackson, 

(467) 


468  MEMORIAL  SERVICES. 

of  Danville,  and  was  brought  by  him  to  the 
attention  of  the  Kentucky  State  Medical 
Society,  and  from  thence  before  the  American 
Medical  Association.  Quite  a  number  of  sub- 
scriptions were  made  to  this  object  by  members 
of  the  National  Association,  but  at  the  meeting 
in  Louisville,  in  1875,  tne  Association  adopted 
a  resolution  creating  a  Prize-essay  Fund  for 
the  perpetuation  of  McDowell's  great  achieve- 
ment. The  resolution  left  to  the  profession  of 
Kentucky  the  work  of  placing  some  local 
memorial  over  his  grave.  The  death  of  Dr. 
Jackson  occurring  soon  afterward,  the  Ken- 
tucky State  Medical  Society  intrusted  the  work 
to  Dr.  Lewis  S.  McMurtry,  of  Danville,  the 
pupil  and  friend  of  Dr.  Jackson.  To  his 
energy  and  perseverance,  under  many  dis- 
couraging circumstances,  the  complete  and 
perfect  success  of  the  enterprise  is  attribut- 
able. In  addition  to  those  made  by  the  mem- 
bers of  the  Kentucky  State  Medical  Society 
subscriptions  toward  the  erection  of  a  monu- 
ment to  McDowell  were  made  by  Dr.  Lewis  A. 
Sayre,  of  New  York,  Dr.  Samuel  D.  Gross  and 
the  late  Dr.  Washington  L.  Atlee,  of  Philadel- 
phia, the  late  Dr.  Edmund  R.  Peaslee,  of  New 
York,  and  Dr.  J.  A.  Murphy,  of  Cincinnati. 


MEMORIAL  SERVICES,  ^gg 

The  monument  is  a  handsome  shaft  made 
from  Virginia  granite.  Midway  on  the  shaft 
is  a  bronze  medallion  of  McDowell,  and  be- 
neath the  medallion  his  monogram  with  the 
motto,  "  Honor  to  whom  honoris  due."  Upon 
the  front  face  of  the  monument  is  the  following- 
inscription,  encircled  with  a  laurel  wreath  :  "A 
grateful  profession  reveres  his  memory  and 
treasures  his  example."  On  the  opposite  side 
is  inscribed,  "Erected  by  the  Kentucky  State 
Medical  Society,  1879."  On  the  eastern  face 
this  inscription :  "  Beneath  this  shaft  rests 
Ephraim  McDowell,  M.D.,  the  'Father  of 
Ovariotomy,'  who,  by  originating  a  great  sur- 
gical operation,  became  a  benefactor  of  his 
race,  known  and  honored  throughout  the 
civilized  world.''  The  western  face  is  devoted 
to  the  historic  inscriptions  as  follows,  being 
encircled  with  the  yEsculapian  serpent :  "Born 
in  Rockbridge  County,  Virginia,  1771 ;  attended 
the  University  of  Edinburgh,  1 793  ;  located  in 
Danville,  Ky.,  1795;  performed  the  first  ovari- 
otomy 1809;  died  1830."  The  monument  is 
beautifully  located  near  the  centre  of  the  city  of 
Danville,  in  a  park  of  several  acres,  which,  by 
subscription  of  the  citizens  of  that  place,  has 
been  beautified  and  made  suitable  for  the 
purpose. 


ajq  MEMORIAL  SERVICES. 

The  dedication  of  the  monument  occurred  on 
the  14th  of  May,  during  the  session-  of  the 
Kentucky  State  Medical  Society  at  Danville. 
These  services  were  unusually  interesting  and 
imposing.  An  immense  audience  composed 
of  the  members  of  the  Society,  and  of  ladies 
and  gentlemen  from  all  parts  of  the  State, 
assembled  to  witness  them,  and  to  honor  the 
memory  of  a  great  man.  In  addition  to  the 
members  of  the  Society,  the  Governor,  the 
Secretary  of  State,  the  speakers  of  the  two 
houses,  and  other  officials,  the  following  well- 
known  physicians  and  surgeons  of  other  States 
occupied  seats  on  the  platform  :  Dr.  Gilman 
Kimball,  Lowell,  Mass.  (who  has  performed 
ovariotomy  two  hundred  and  thirty-nine  times)  ; 
Drs.  Whittaker,  Seely,  Ayres,  and  Stevens,  of 
Cincinnati ;  and  Dr.  McDowell,  of  St.  Louis, 
and  Drs.  V.  P.  Gibney  arid  Lewis  A.  Sayre, 
of  New  York  City. 

The  committee  regrets  exceedingly  that  a 
letter  addressed  it  by  Dr.  Fordyce  Barker, 
President  of  the  New  York  Academy  of  Medi- 
cine, failed  to  reach  its  destination. 

Coleman  Rogers, 
Preston  B.  Scott, 
J.  W.  Holland, 

Committee  of  Publication. 


MEMORIAL  SERVICES.  471 

Louisville,  Ky.,  May  17,  1879. 

Dr.  L.  S-.  McMurtry, 

Chairman  McDowell  Monument  Committee,  Danville. 

Dear  Sir:  In  accordance  with  the  resolution 
adopted  by  the  Kentucky  State  Medical  So- 
ciety on  the  15th  of  May,  I  would  respectfully 
request  you  to  forward  me  for  publication  the 
Proceedings  of  the  McDowell  Memorial  Exer- 
cises,  held  in  your  city  on  the  14th  instant. 
I  am,  very  respectfully, 

Coleman  Rogers, 

Chairman  Committee  of  Publication. 


Danville,  Ky.,  June  19,  1879. 

Dr.  Coleman  Rogers, 

Chairman  of  the  Committee  of  Publication,  Louisville. 

Dear  Sir:  I  have  the  honor  to  send  herewith 
the  Proceedings  connected  with  the  Dedication 
of  the  McDowell  Monument,  as  requested  in 
your  favor  of  the  1 7th  instant. 

I  am,  yours,  etc., 

L.  S.  McMurtry, 

Chairman  McDowell  Monument  Committee. 


DEDICATORY   ADDRESS. 

BY  PROF.  SAMUEL  D.  GROSS,  M.D. 

Gentlemen  of  the  Kentucky  State  Medi- 
cal Society,  Ladies  and  Gentlemen:  Nearly 
fifty  years  ago  the  citizens  of  Danville,  then 
a  small,  obscure  village,  carried  to  its  last 
resting-place  all  that  was  mortal  of  the  man 
whose  monument  will  henceforth  mark  an  era 
in  the  history  of  the  medical  profession  and 
of  the  people  of  Kentucky.  The  announce- 
ment of  his  death,  after  a  brief  illness,  in  the 
fifty-ninth  year  of  his  age,  on  the  20th  of  June, 
1830,  caused  deep  and  wide-spread  grief  in  the 
community  in  which  he  had  so  long  lived,  and 
of  which  he  had  been  so  conspicuous,  honored, 
and  beloved  a  member.  By  none  was  his  loss 
more  profoundly  deplored  than  by  the  poor  of 
Danville  and  its  neighborhood,  who  had  been 
so  frequently  benefited  by  his  skill  and  so  fre- 
quently the  recipients  of  his  bounty.  Many  a 
tear  was  shed  as  the  body  was  tenderly  laid  in 

the  earth,  and  many  a  sigh  was  heaved  as  the 

(472) 


DEDICA  TOR  Y  ADDRESS. 


473 


reflection  came  that  the  mantle  of  such  a  man 
would  be  long  in  finding  worthy  shoulders.  Of 
those  who  were  present  on  that  melancholy 
occasion,  one  after  another  has  disappeared. 
New  generations  have  sprung  up,  and  a  scene 
that  wrapped  a  whole  community  in  sorrow  and 
caused  general  regret  in  the  American  medical 
profession  is  with  most  of  the  people  of  this 
section  of  Kentucky  a  mere  tradition.  The 
marble  slab  erected  by  the  hand  of  affection 
over  the  mortal  remains  bears  the  simple  but 
significant  inscription,  Ephraim  McDowell. 

Who  was  this  man,  this  Ephraim  McDowell, 
in  honor  of  whose  memory  we  have  assembled 
here  this  evening  ?  Was  he  a  hero  whose  body 
was  scarred  as  he  was  leading  his  armies  in  the 
defence  of  his  country?  Was  he  a  great  magis- 
trate, meting  out  justice  to  his  fellow-citizens, 
protecting  their  rights,  and  wisely  interpreting 
their  laws  ?  Was  he  a  legislator,  devising 
means  for  the  development  of  the  resources  of 
his  state,  and  the  promotion  of  the  happiness 
of  society  ?  Was  he  a  great  senator,  like  Clay, 
or  Crittenden,  or  Webster,  expounding  the 
constitution  and  convulsing  the  American 
people  by  the  power  and  majesty  of  his 
eloquence  ?     Ephraim  McDowell  was  not  any 


474  MEMORIAL  SERVICES. 

of  these,  and  yet  he  was  none  the  less  a  good 
and  a  wise  man,  nor  is  he  any  the  less  entitled 
to  the  world's  gratitude.  Following  the  noble 
vocation  of  a  practitioner  of  the  healing  art, 
liberally  dispensing  alike  to  poor  and  rich  the 
blessings  of  his  knowledge  and  of  his  skill,  he 
silently  pursued  the  even  tenor  of  his  way,  a 
faithful  servant  of  his  profession,  with  no  am- 
bition for  meretricious  distinction.  It  was  here, 
on  this  very  spot,  that  he  achieved  that  renown 
which  so  justly  entitles  him  to  be  ranked  among 
the  benefactors  of  his  race.  It  was  here,  while 
engaged  in  the  daily  routine  of  his  calling,  that 
he  performed  an  exploit  which  no  one  had  ever 
achieved  before,  and  which,  although  for  a  long 
time  denounced  and  condemned  by  many  other- 
wise enlightened  surgeons  and  practitioners  as 
an  outrageous,  if  not  murderous,  innovation,  is 
now  universally  admitted  as  one  of  the  estab- 
lished procedures  in  surgery ;  an  operation 
which,  in  its  aggregate  results  in  the  hands  of 
different  surgeons,  has  already  added  upwards 
of  forty  thousand  years  to  woman's  life,  and 
which  is  destined,  as  time  rolls  on,  to  rescue 
thousands  upon  thousands  of  human  beings 
from  premature  destruction. 

Ephraim   McDowell  will  be  regarded  in  all 


DEDICA  TOR  Y  ADDRESS.  47  5 

time  to  come  as  the  "Father  of  Ovariotomy," 
and  as  one  of  the  master  spirits  of  his  profes- 
sion.    We  are  here  this  evening  to  place  upon 
his  tomb  a  wreath  of  immortelles  expressive  of 
our  admiration  and  respect,  and  of  the  grati- 
tude of  more  than  two  thousand  women  rescued 
from  an  untimely  grave  by  his  operation.     That 
his  claims  to  this  distinction  are  well  founded 
the  history  of  this  operation  abundantly  attests. 
For  a  long  time  it  was  thought  that  other  sur- 
geons had  anticipated  him  in  this  undertaking, 
but  all  the  doubt  that  had  hung  over  the  sub- 
ject was  at  length  completely  dispelled  in  1852 
in  an  address  which  I  had  the  honor  to  read 
before  the  Kentucky  State  Medical  Society  at 
its  annual  meeting  at  Louisville,   entitled   "A 
Report  on   Kentucky  Surgery."      In  the  prose- 
cution of  my  inquiries  I  became  deeply  inte- 
rested in  the  subject  of  ovariotomy,  and  espe- 
cially in  the  claims  of  McDowell  as  its  origi- 
nator.    With  this  end  in  view  I  engaged  in  a 
long  and  laborious  correspondence,  in  which  I 
was  kindly  assisted  by  Professor  Daniel  Drake, 
Dr.  William   Gait,   and    Dr.   William   A.    Mc- 
Dowell, a  nephew  and  at  one  time  a  partner 
of  the  great  surgeon.     Letters  were  addressed 
to  physicians  in  different  parts  of  the  State,  and 


,76  MEMORIAL  SERVICES. 

also  to  the  surviving  members  of  Dr.  Mc- 
Dowell's family,  asking  for  information  re- 
specting the  number  and  results  of  his  cases, 
as  well  as  the  names  and  residences  of  his 
patients,  and  any  other  intelligence  calculated 
to  throw  light  upon  his  life  and  character; 
matters  concerning  which,  up  to  that  period, 
hardly  anything  definite  was  known.  These 
documents  are  still  in  my  possession,  and  will 
probably  at  no  distant  day  be  given  to  the 
public. 

When  this  investigation  was  begun  the 
origin  of  this  operation  was  generally  ascribed 
to  a  French  surgeon,  L'Aumonier,  of  Rouen, 
who,  it  was  contended,  had  performed  it  in 
1782,  when  McDowell  was  not  eleven  years 
old.  More  recently  the  honor  has  been  claimed 
by  our  British  brethren  for  Dr.  Robert  Hous- 
ton, of  Glasgow,  whose  name  appears  in  con- 
nection with  an  operation  upon  the  ovary  as 
early  as  1701.  The  operation,  however,  has 
been  found  upon  a  careful  examination  of  the 
history  of  the  case  to  be  entirely  different  from 
that  of  the  Kentucky  surgeon.  The  case  was 
simply  one  of  ovarian  tumor,  the  contents  of 
which  were  partially  evacuated  by  an  incision 
made  through  the  abdomen,  the  cyst  itself 
being  left  behind. 


DEDICA  TOR  Y  ADDRESS.  477 

These  and  other  pretensions  that  have  been 
set  up  by  different  nationalities  are  wholly  un- 
supported by  facts  ;  for  a  careful  study  of  the 
cases  which  have  been  reported  by  their  respec- 
tive operators  will  serve  to  convince  any  un- 
prejudiced mind  that,  so  far  from  being  exam- 
ples of  ovariotomy,  they  were  simply  instances 
of  cystic  tumors,  similar  to  those  already  men- 
tioned in  connection  with  the  names  of  L'Aumo- 
nier  and  Houston.  Indeed  a  considerable 
number  of  such  operations  were  performed 
during  the  last  century,  chiefly  by  French,  Ger- 
man, and  English  surgeons,  or,  as  they  would 
now  call  themselves,  if  living,  gynecologists. 

The  first  actual  case  of  ovariotomy  of  which 
there  is  any  authentic  account  occurred  in  this 
town  in  December,  1809,  in  the  hands  of  Dr. 
Ephraim  McDowell,  and  to  him  and  to  him 
alone  is  due  the  credit  of  having  devised  and 
first  successfully  executed  the  operation.  All 
honor,  then,  we  say,  to  the  man  who  thus  paved 
the  way  to  a  new  path  of  humanity,  since  so 
nobly  trodden  by  his  successors  !  All  honor  to 
the  man  who  had  the  courage  and  skill  to  do 
that  which  no  man  had  ever  dared  to  do  be- 
fore !  All  honor,  too,  to  the  heroic  woman 
who,  with  death  literally  staring  her  in  the  face, 


478  MEMORIAL  SERVICES. 

was  the  first  to  submit  calmly  and  resignedly  to 
what  certainly  was  at  the  time  a  surgical  ex- 
periment. To  her,  too,  let  a  monument  be 
erected,  not  by  the  Kentucky  State  Medical 
Society  or  by  the  citizens  of  Kentucky,  but  by 
suffering  women  who,  with  her  example  before 
them,  have  been  the  recipients  of  the  inestimable 
boon  of  ovariotomy,  with  a  new  lease  of  their 
lives  and  with  immunity  from  subsequent  dis- 
comfort and  distress.  I  know  of  no  greater 
example  in  all  history  of  heroism  than  that  dis- 
played by  this  noble  woman  in  submitting  to  an 
untried  operation.  McDowell  himself  must 
have  been  startled,  if  not  absolutely  abashed, 
when  he  found  how  willing-  she  was.  after  he 
had  depicted  to  her,  in  the  most  glowing  colors 
and  in  the  strongest  and  plainest  language,  the 
risks  of  the  operation.  When  a  surgeon,  how- 
ever experienced  or  skilful,  meets  with  a  des- 
perate case,  and  finds  that,  after  having  in- 
formed his  patient,  that  if  an  operation  be 
performed,  it  will,  be  likely  to  destroy  him,  he 
is  willing  and  ready  to  incur  the  risk,  his  heart 
often  fails  him  and  he  deeply  regrets  that  the 
poor  sufferer  ever  fell  into  his  hands.  So,  no 
doubt,  McDowell  felt  upon  this  occasion. 
"  Having  never,"  he  said,  "seen  so  large  a  sub- 


DEDICATORY  ADDRESS.  479 

stance  extracted   nor  heard  of  an  attempt  or 
success  attending  any  operation    such  as  this 
required,  I  gave  to  the  unhappy  woman  infor- 
mation of  her  dangerous  situation.     She  seemed 
willing   to    undergo   an    experiment,    which   I 
promised  to  perform  if  she  would  come  to  Dan- 
ville, the  town  where  I  live,  a  distance  of  sixty 
miles."     She  did  come,  and  the  experiment,  as 
McDowell  very  properly  calls  it,  was,  as  already 
stated,  performed.     A  rapid  recovery  ensued, 
and  the  patient,   Mrs.  Crawford,  a    Kentucky 
lady,  survived  the  operation   thirty-two    years, 
enjoying  for  the  most  part  excellent  health,  and 
dying  at  length  in  the  seventy-ninth  year  of  her 
age.     Thus,    it   will  be   seen,    this   heroic  and 
courageous  woman   owed   nearly  two-fifths  of 
her  life  to  the  skill  and  care  of  her  surgeon. 
Our  admiration  of  this  noble  woman  is  greatly 
enhanced  when  we  reflect  that  the    operation 
was  performed  without  the  aid  of  anaesthetics, 
which  were  not  introduced  into  practice  until  a 
third  of  a  century  afterward,  as  is  our  admira- 
tion of  the  surgeon  when  we  recall  the  fact  that 
he  had  no  trained  assistants  to  aid  him  in  his 
work,  executed  despite  the  most  strenuous  and 
persistent  efforts  to  dissuade  him  from  under- 
taking it. 


480 


MEMORIAL  SERVICES. 


It  is  not  a  little  remarkable  that  no  account 
of  this  operation  was  published  until  eight  years 
after  it  was  performed.  Whether  this  was  due 
to  inherent  modesty  on  the  part  of  McDowell, 
to  indifference  to  fame,  to  sheer  apathy,  to  an 
aversion  to  writing,  or  to  fear  of  criticism,  to 
which  such  an  undertaking,  without  a  precedent 
in  the  annals  of  surgery,  would  necessarily  ex- 
pose him,  it  would  be  idle  to  conjecture.  It  is 
sufficient  for  my  purpose  to  know  that  the  first 
notice  of  it  appeared,  in  1817,  in  the  Philadel- 
phia Eclectic  Repei'tory  and  Analytical  Review. 
The  communication,  which  covered  not  quite 
three  octavo  pages  of  printed  matter,  was  en- 
titled "  Three  Cases  of  Extirpation  of  Diseased 
Ovaria,"  and  was  drawn  up  so  loosely  and  care- 
lessly as  to  be  well  calculated  to  elicit  adverse 
criticism,  as  indeed  it  speedily  did  both  at  home 
and  abroad  in  a  way  not  at  all  calculated  to  re- 
flect credit  upon  the  author  as  a  literary  and 
scientific  man.  The  details  of  the  cases  were 
singularly  meagre  ;  there  was  nothing  said  re- 
specting their  origin,  progress,  or  diagnosis, 
and  even  the  operations  themselves  were  very 
imperfectly  described.  If  such  operations  had 
been  performed  in  our  day  the  most  minute 
circumstances  would  have  speedily  found  their 


DEDICA  TOR  Y  ADDRESS.  48 1 

way  into  print.  The  fact  is,  McDowell  pos- 
sessed no  facility  as  a  writer,  and  he  lacked  that 
grace  of  diction  and  power  of  expression  so 
well  adapted  to  impart  interest  even  to  the 
driest  details,  and  which  can  be  acquired  only 
by  long  practice.  In  a  word,  he  was  a  stranger 
to  the  pen  and  had  no  fancy  for  its  use.  Writ- 
ing was  a  great  bore  to  him ;  a  compulsory 
necessity.  The  report  of  his  cases  soon  after 
its  publication  was  severely  criticised,  and  an 
attempt  was  made  to  discredit  his  statements, 
or,  in  other  terms,  to  impugn  his  veracity. 
Had  McDowell  lived  in  our  day,  when  intelli- 
gence flashes  with  lightning  speed,  not  only 
from  one  section  of  the  country  to  another  but 
from  continent  to  continent,  such  an  occurrence 
would  not  have  been  possible. 

Dr.  James  Johnson,  the  very  able  and  learned 
editor  of  the  London  Medico- Chirurgical  Re- 
view, a  journal  widely  circulated  both  in  Great 
Britain  and  in  the  United  States,  was  especially 
savage  and  satirical.  He  could  not  imagine  it 
to  be  possible  that  an  American  surgeont  living 
in  a  small,  obscure  village  in  the  wilds  of  Ken- 
tucky, or  in  the  backwoods  of  America,  as  he 
expressed  it,  could  perform  such  an  operation, 

or  become  a  pioneer  in  a  new  branch  of  sur- 
'  31 


482  MEMORIAL  SERVICES. 

gery.  In  commenting  upon  McDowell's  first 
case,  especially  upon  the  wonderfully  rapid 
recovery  of  the  patient,  he  exclaims  apparently 
in  holy  horror  and  with  uplifted  hands,  "Credat 
yudmis  non  egoy  In  a  subsequent  article, 
published  in  1826,  Johnson  again  calls  attention 
to  McDowell's  cases,  adding  that  of  five  cases 
reported  four  had  recovered  and  only  one  had 
died.  "There  were  circumstances,"  remarks 
this  Cerberus,  "  in  the  narratives  of  some  of 
the  first  cases  that  raised  misgivings  in  our 
minds,  for  which  uncharitableness  we  ask  par- 
don of  God,  and  of  Dr.  Ephraim  McDowell,  of 
Danville."  It  is  presumable  that  this  frank  and 
manly  recantation  on  the  part  of  a  man  who 
occupied  so  elevated  and  influential  a  position 
as  the  editorship  of  the  most  widely  read  medi- 
cal journal  in  the  world  had  some  effect  in 
controlling  professional  sentiment  and  inspiring 
confidence  in  the  declarations  of  a  suro-eon 
whom  he  had  only  a  few  years  before  de- 
nounced as  a  backwoods  operator  unworthy  of 
credence.  Nevertheless  Dr.  McDowell  had  for 
a  long  time  no  imitators.  Among  those  who, 
on  this  side  of  the  Atlantic,  had  the  courage  to 
follow  in  his  footsteps,  were  Nathan  Smith,  of 
New  Haven,  in   1821,  Alban  G.  Smith,  a  part- 


DEDICA  TOR  Y  ADDRESS.  4  g  3 

ner  of  McDowell,  in  1823,  and  Dr.  David  L. 
Rogers,  of  New  York,  in  1829.  All  of  the 
cases  terminated  favorably.  McDowell  him- 
self, as  clearly  as  I  could  determine  in  prepar- 
ing my  report  on  Kentucky  Surgery,  operated 
altogether  thirteen  times,  with  the  result  of 
eight  cures,  four  deaths,  and  one  failure,  due  to 
an  inability  to  complete  the  operation  on  account 
of  extensive  adhesions  of  the  tumor  ;  a  degree 
of  success  which,  considering  the  fact  that  he 
had  no  precepts  except  his  own  experience  to 
guide  him,  was  eminently  creditable  to  his  judg- 
ment, care,  and  skill,  and  which,  although  ex- 
ceeded in  recent  times,  was  for  a  third  of  a 
century  pretty  much  the  average  in  the  hands 
of  his  followers,  both  in  America  and  in  Europe. 
If  we  go  to  the  other  side  of  the  Atlantic  we 
shall  find  that  the  first  attempt  at  ovariotomy 
in  Great  Britain  occurred  in  the  practice  of  Mr. 
John  Lizars,  of  Edinburgh.  This  gentleman,  in 
1825,  published  a  beautiful  monograph  upon 
the  subject,  in  which  he  gave  a  detailed  account 
of  four  cases,  with  two  recoveries,  one  death, 
and  one  an  utter  and  disgraceful  failure,  due  to 
an  erroneous  diagnosis,  both  ovaries  being  per- 
fectly sound.  Mr.  Lizars,  who  was  a  surgeon 
of  considerable  note  in  his  day,  was  led  to  turn 


484  MEMORIAL  SERVICES. 

his  attention  to  this  subject  from  having  read  an 
account  of  McDowell's  operations,  which  had 
accidentally  fallen  into  his  hands  during  the 
absence  of  Mr.  John  Bell,  McDowell's  old  pre- 
ceptor, upon  the  continent,  from  which  he  never 
returned.  The  brochure  here  referred  to  was, 
there  is  reason  to  believe,  of  great  service  in 
calling  to  the  subject  the  attention  of  European 
surgeons  generally,  the  more  especially  as  it 
embraced  a  full  report  of  the  Kentucky  cases, 
which,  up  to  that  period,  had  lain,  as  it  were, 
in  a  state  of  dormancy.  Nothing,  however,  of 
any  moment  was  done  anywhere,  either  at 
home  or  abroad,  until  1842,  when  ovariotomy 
received  a  new  impulse  at  the  hands  of  Dr. 
Charles  Clay,  of  Manchester,  England,  followed 
shortly  after  by  Dr.  Frederick  Bird,  of  London, 
and  the  two  brothers  Atlee,  John  and  Washing- 
ton, of  Pennsylvania,  the  first  case  of  the  for- 
mer having  occurred  in  1843  and  that  of  the 
latter  in  1844.  To  these  gentlemen  is  unques- 
tionably due  the  great  merit  of  reviving  the 
operation  and  of  placing  it  upon  a  firm  and 
immutable  basis  as  one  of  the  established  pro- 
cedures in  surgery.  Their  attempts  to  gene- 
ralize the  operation  met  everywhere  with  great 
opposition  and  even  obloquy.      Dr.  Clay,  who 


DED1CA  TOR  Y  ADDRESS.  a  g  c 

introduced  it  into  England,  in  referring  to  the 
subject,  states  that  he  had  to  wade  through 
much  vexatious  opposition,  great  misapprehen- 
sions, and  gross  misunderstandings  ;  and  the 
experience  of  Dr.  Washington  L.  Atlee  was 
still  more  trying  and  annoying.  In  an  address 
which  he  delivered  in  1872  before  the  Philadel- 
phia County  Medical  Society,  entitled  "  A 
Retrospect  of  the  Struggles  and  Triumphs  of 
Ovariotomy  in  Philadelphia,"  he  depicts  in 
glowing  language  the  obstacles  which  this  ope- 
ration had  to  encounter  in  this  country  and  in 
his  own  city.  "Ovariotomy,"  he  exclaims, 
"was  everywhere  derided.  It  was  denounced 
by  the  general  profession,  in  the  medical  socie- 
ties, in  all  the  medical  colleges,  and  even  by 
the  majority  of  my  own  colleagues.  I  was 
misrepresented  before  the  medical  public,  and 
was  pointed  at  as  a  dangerous  man,  and  even 
as  a  murderer.  The  opposition  went  so  far 
that  a  celebrated  professor,  a  popular  teacher, 
and  captivating  writer,  in  his  public  lectures, 
invoked  the  law  to  arrest  me  in  the  perform- 
ance of  this  operation."  This  rancorous  oppo- 
sition, however,  founded  as  it  was  upon  ignor- 
ance and  prejudice,  gradually  wore  away,  and 
the  men  who  were  most  clamorous  in  keeping 


4S6  MEMORIAL  SERVICES. 

it  up  either  disappeared  from  the  active  scenes 
of  life,  or  yielded  gracefully  to  the  light  of 
reason  and  experience.  Dr.  Clay,  writing  in 
1874,  states  that  he  had  operated  upon  two 
hundred  and  seventy-six  cases,  while  those  of 
Dr.  Atlee,  at  the  time  of  his  death,  less  than  a 
year  ago,  amounted  to  three  hundred  and 
eighty-seven.  Mr.  T.  Spencer  Wells,  of  Lon- 
don, whose  brilliant  career  as  an  ovariotomist 
began  in  1858,  wrote  to  me  on  the  29th  of 
April,  1879,  that  he  had  just  had  his  nine  hun- 
dred and  thirty-eighth  case.  Mr.  Thomas 
Keith,  of  Edinburgh,  whose  career  in  this  field 
of  surgery  is  also  wonderfully  brilliant,  informs 
me,  in  a  letter  written  a  short  time  previously 
to  that  of  his  English  confrere,  that  he  had  ope- 
rated up  to  that  date  two  hundred  and  eighty- 
four  times.  Dr.  John  L.  Atlee  has  operated 
fifty-seven  times ;  Dr.  Alexander  Dunlap,  of 
Ohio,  one  hundred  and  forty-three  times  ;  Dr. 
Edmund  R.  Peaslee,  seventy-seven  times ; 
Dr.  T.  Gaillard  Thomas,  one  hundred  and 
twenty-six  times,  and  Dr.  Gilman  Kimball,  the 
oldest  and  most-renowned  American  ovarioto- 
mist since  the  death  of  Dr.  Washington  L. 
Atlee>  two  hundred  and  forty  times.  Professor 
Briggs,  of  Nashville,  who  has  operated  upwards 


DEDICA  TOR  Y  ADDRESS.  487 

of  fifty  times,  recently  had  three  cases  of  ovari- 
otomy on  the  same  day,  the  patients  living 
within  a  short  distance  of  each  other. 

It  is  an  interesting  fact  with  regard  to  the 
history  of  ovariotomy  in  this  country  that  Dr. 
John  L.  Atlee's  first  operation,  performed  in 
1843,  was  also  the  first  operation  in  which  both 
ovaries  were  removed.  In  the  report  of  this 
remarkable  case,  an  unusually  elaborate  one, 
in  the  American  Journal  of  the  Medical  Sciences 
for  January,  1844,  after  instituting  a  compari- 
son between  this  and  other  capital  operations, 
Dr.  Atlee  makes  a  strong  appeal  in  favor  of 
ovariotomy.  "Let  this  operation,"  he  says, 
"but  be  placed  upon  its  legitimate  basis,  and 
let  it  receive  that  attention  from  the  profession 
which  has  been  devoted  to  other  departments 
of  surgery,  and  we  shall  soon  arrive  at  such  a 
knowledge  of  the  proper  time  and  manner  of 
operating,  and  before  those  complications  exist 
which  render  it  impracticable,  as  will  be  the 
means  of  saving  many  unfortunate  and  hope- 
less victims."  When  this  operation  was  per- 
formed Dr.  Atlee  was  not  aware  of  the  cases 
that  had  occurred  in  England  in  the  practice  of 
Dr.  Clay  and  Mr.  Walne,  and  he  informs  me 
that  he  would  never  have  performed  it  if  he 


A88  MEMORIAL  SERVICES. 

had  not  studied  with  great  care  the  report  of 
McDowell's  cases.  The  success  of  his  opera- 
tion, one  of  the  most  brilliant  on  record,  in- 
duced him  and  his  brother  to  repeat  it  on  the 
first  favorable  opportunity,  despite  the  opposi- 
tion and  clamor  of  their  professional  brethren. 
Up  to  1850  only  eighteen  American  surgeons, 
including  the  originator,  had  performed  this 
operation.  In  1855  it  received  a  new  impulse 
from  the  publication  of  Dr.  Washington  L. 
Atlee's  first  thirty-five  cases,  and  in  the  follow- 
ing year  appeared  the  admirable  prize-essay  of 
Dr.  George  H.  Lyman,  of  Boston,  entitled 
"The  History  and  Statistics  of  Ovariotomy," 
embracing  a  summary  of  three  hundred  cases, 
being  all  that  were  then  known  as  having 
occurred  in  different  parts  of  the  world.  On 
the  continent  of  Europe  ovariotomy  made, 
until  recently,  very  slow  progress,  although 
Chrysmar,  of  Germany,  had  performed  it  three 
times  before  the  close  of  1820,  and  conse- 
quently several  years  before  it  was  attempted 
by  Lizars,  of  Edinburgh.  In  France  it  was 
performed  for  the  first  time  in  1847.  ^n  these 
countries,  as  in  the  United  States  and  Great 
Britain,  it  was  long  denounced  as  an  unsafe 
and  improper  operation,  and  that  this  should 


DEDICA  TOR  Y  ADDRESS.  489 

have  been  the  case  is  not  surprising  when  we 
consider  the  enormous  mortality  which  attended 
it,  even  in  the  hands  of  many  of  the  most 
accomplished  surgeons.  The  results  of  late 
years,  however,  have  been  more  encouraging, 
and  have  been  particularly  flattering  in  the 
hands  of  Koeberle,  of  Strasbourg,  Schroeder, 
of  Berlin,  and  Skoeldberg,  of  Sweden,  not  to 
mention  others.  Ovariotomy  is  no  longer  on 
trial ;  it  has  successfully  passed  that  ordeal, 
and  is  now  performed  in  every  country  of  the 
earth  where  civilization  has  carried  the  bless- 
ings of  scientific  medicine. 

The  frequency  of  ovarian  diseases  is  appal- 
ling; far  greater,  indeed,  than  it  is  generally 
supposed  to  be.  One  surgeon  alone,  Dr.  Clay, 
of  England,  declares  that  he  had  examined 
within  a  single  decade  eight  hundred  and  fifty 
cases !  Who,  in  view  of  these  occurrences, 
will  deny  the  blessings  of  ovariotomy,  espe- 
cially when  we  take  into  consideration  the  fact 
that  few  women  laboring  under  maladies  of  this 
kind  live  longer  than  about  four  years,  unless 
relieved  by  surgical  interference  ? 

The  mortality  of  this  operation  is  worthy  of 
brief  notice  in  connection  with  Dr.  McDowell's 
name  and  fame.     His  own  cases — thirteen  in 


49<3  MEMORIAL  SERVICES. 

number,  with  eight  cures,  four  deaths,  and  one 
failure  to  complete  the  operation  on  account 
of  extensive  adhesions — show  an  astonishing 
degree  of  success  when  we  recollect  all  the 
circumstances  attending  them,  especially  the 
operator's  own  inexperience,  and  the  absence 
of  any  rules  to  guide  him  in  his  undertakings. 
For  a  number  of  years  after  McDowell's  death 
the  mortality  in  the  hands  of  different  surgeons 
exhibited  but  little  improvement  upon  that  in 
his  own  practice.  Thus,  of  one  thousand  four 
hundred  and  eight  cases  collected  by  me  in 
1872,  from  various  sources,  native  and  foreign, 
four  hundred  and  fifteen  died,  affording-  a  mor- 
tality  of  twenty-four  per  cent,  or  one  death  in 
every  three  and  two-fifths  cases.  That  the 
results  of  the  operation  are  materially  influ- 
enced by  the  manner  in  which  it  is  performed, 
and  by  the  previous  and  subsequent  treatment, 
is  a  fact  long  since  fully  established.  Thus,  if 
we  take  the  statistics  of  one  hundred  cases  in 
the  hands  of  so  many  different  surgeons,  men 
who  have  no  experience  in  such  cases  and  who 
follow  the  ordinary  method  of  operating,  the 
mortality  will  be  found  to  be  enormous,  just  as 
it  would  be  likely  to  be  under  similar  circum- 
stances in  any  other  grave  operation,   as  lith- 


DEDICA  TOR  Y  ADDRESS. 


49 1 


otomy,  the  larger  amputations,  trephining  of 
the  skull,  and  the  ligation  of  the  larger  arteries. 
No  one  will  deny  that  experience  is  a  most 
important  factor  in  saving  or  destroying  life  in 
all  the  more  serious,  severe,  or  capital  opera- 
tions. The  results  of  ovariotomy  in  the  hands 
of  professed  or  skilled  ovariotomists,  men  who 
make  a  specialty  of  abdominal  surgery,  are 
among  the  greatest  triumphs  of  our  art,  en- 
titling them  to  be  ranked  among  the  noblest 
benefactors  of  the  present  day,  or  indeed  of 
any  day.  The  cases  of  Washington  L.  Atlee, 
Charles  Clay,  T.  Spencer  Wells,  Thomas  Keith, 
Gilman  Kimball,  Alexander  Dunlap,  T.  Gaillard 
Thomas,  and  others,  are  counted,  not  by  tens 
or  twenties  or  thirties,  but  by  hundreds.  It  is 
this  enormous  multiplication  of  cases  that  makes 
these  men  such  experts  and  that  gives  them 
such  a  superiority  over  those  whose  practice  is 
comparatively  limited.  One  of  the  most  grati- 
fying circumstances  connected  with  this  opera- 
tion is  the  gradually  decreasing  mortality  even 
in  the  hands  of  the  most  successful  sureeons. 
This  is  strikingly  shown,  to  go  no  farther,  by 
the  statistics  of  Dr.  Clay,  of  Manchester,  who, 
as  previously  stated,  introduced  ovariotomy 
into  England.     Of  the  first  twenty  cases   the 


492 


MEMORIAL  SERVICES. 


death-rate  was  one  in  two  and  one-half ;  of  the 
second  twenty,  one  in  three  and  one-third  ;  and 
of  the  last  thirty-one,  one  in  four.  In  Mr. 
Wells's  cases  the  same  gratifying  results  are 
apparent,  and  so  also  in  those  of  Mr.  Keith,  of 
Edinburgh.  Who  will  dare  to  assert  that  these 
triumphs  are  not  due  to  superior  skill  in  operat- 
ing, and  to  increased  care  and  experience,  and 
not  to  the  selection  of  the  cases,  although  this 
will  doubtless,  now  that  the  diagnosis  between 
innocent  and  benign  ovarian  diseases  is  so  well 
established,  have  its  influence  ? 

The  attention  bestowed  upon  the  after-treat- 
ment must  necessarily  exert  a  powerful  influ- 
ence upon  the  patient's  fate.  All  the  professed 
ovariotomists  employ  trained  and  experienced 
nurses  and  personally  superintend  their  cases 
from  first  to  last.  Mr.  Keith,  in  referring  to 
this  subject,  says,  "  No  one  knows  the  anxiety 
that  ovariotomy  has  given  me,  nor  the  time  and 
thought  and  care  I  have  bestowed  on  the  pa- 
tients." There  can  be  no  doubt  that  the 
chances  of  recovery  after  the  operation  are 
greater  when  the  patient  is  treated  in  a  private 
hospital,  situated  upon  airy  ground,  and  pro- 
vided with  all  the  means  and  appliances  which 
such  an  institution  ought  to  possess.     This  fact 


DEDICA  TOR  Y  ADDRESS. 


493 


has  been  strikingly  exemplified  in  the  practice 
of  Mr.  Keith,  and  also  in  that  of  Mr.  Wells 
while  he  was  in  charge  of  the  Samaritan  Hos- 
pital, London. 

Leaving-  out  of  the  question  the  results  of 
less-experienced  ovariotomists,  what  can  be 
more  wonderful  than  the  results  of  Mr.  Keith's 
cases — two  hundred  and  eighty-four — with  a 
mortality  of  only  thirty-five,  or  one  death  in 
about  eight  operations  ?  Of  the  last  one  hun- 
dred and  fifty-eight  cases  only  twelve  suc- 
cumbed ;  of  the  last  seventy-seven  only  thir- 
teen, and  of  the  last  forty-nine  not  one,  thus 
verifying  his  assertion  that  "this  long-despised 
operation  is  now  the  safest  of  all  the  great 
surgical  operations,  at  least  judging  from  these 
results."  The  statistics  of  the  operations  of 
Mr.  Wells  are  equally  astonishing.  Both  these 
surgeons  are  now  making  constant  use  of  anti- 
septics, notwithstanding  they  obtained  most 
brilliant  results  from  the  ordinary  treatment, 
conducted  with  that  care  which  their  increasing- 
experience  had  taught  them  to  employ.  Mr. 
Keith  does  not  hesitate  to  ascribe  much  of  his 
wonderful  success  in  his  late  cases  to  the  effi- 
cacy of  antiseptics.  Mr.  Wells,  in  the  letter 
previously  referred  to,  says  :   "I  began  the  year 


aqa  MEMORIAL  SERVICES. 

1878  with  the  eight  hundred  and  eighty-eighth 
case,  by  adopting  the  antiseptic  system  of  Lis- 
ter, and  have  kept  it  up  ever  since,  the  result 
of  forty-five  cases  being  forty  recoveries  and 
five  deaths.  The  recoveries  have  taken  place, 
as  a  rule,  without  fever."  "  I  believe,"  he  adds, 
"  that  the  antiseptic  system  will  certainly  reduce 
mortality  and  expedite  convalescence."  Of  the 
thirty-eight  cases  of  the  ninth  hundred,  the 
number  operated  upon  by  Mr.  Wells  up  to 
April  29,  five,  he  informs  me,  have  died,  and 
thirty-three  are  well  or  convalescing.  Of  Mr. 
Clay's  two  hundred  and  seventy-six  cases  two 
hundred  recovered  and  seventy-six  died. 
Koeberle,  during  the  last  four  years,  operated 
one  hundred  times  with  eleven  deaths. 

The  mortality  in  Dr.  Washington  L.  Atlee's 
three  hundred  and  eighty-seven  cases  was,  as  I 
am  informed  by  his  son-in-law,  Dr.  Thomas  M. 
Drysdale,  about  thirty  per  cent.,  which,  consid- 
ering that  he  did  not  select  his  cases,  and  fre- 
quently had  no  opportunity  of  superintending 
the  after-treatment,  always  a  matter  of  such 
great  moment  in  every  severe  operation,  may 
be  regarded  as  a  fair  average.  Dr.  John  L. 
Atlee's  fifty-seven  cases  show  forty  recoveries 
and  twelve  deaths,  with  five  failures  to  complete 


DEDICA  TOR  Y  ADDRESS.  49 5 

the  operation  on  account  of  extensive  adhesions. 
Of  Dr.  Dunlap's  one  hundred  and  forty-three 
patients  one  hundred  and  twelve  recovered  and 
thirty-one  died.  Of  Dr.  Peaslee's  seventy- 
seven  operations  the  results  of  twenty-eight 
only  are  positively  known,  and  of  these  nine- 
teen recovered  and  nine  perished.  J.  Taylor 
Bradford  had  thirty  cases  with  three  deaths. 
Professor  T.  Gaillard  Thomas's  one  hundred 
and  twenty-nine  cases  show  ninety-six  recov- 
eries and  thirty-three  deaths.  The  mortality 
of  Dr.  Kimball's  cases  is  in  the  ratio  of  one  to 
four  ;  of  his  last  twenty-four  cases  twenty-one 
have  recovered  and  three  have  died. 

It  would  be  foreign  to  my  purpose,  in  an 
address  like  this,  and  especially  before  such  an 
audience,  to  speak  of  the  causes  which  mainly 
influence  the  results  of  this  operation ;  but 
there  is  one  circumstance  to  which  I  cannot 
forbear  alluding.  I  refer  to  the  importance  of 
establishing  in  every  case,  before  an  operation 
is  attempted,  a  correct  diagnosis.  Fortunately 
this  can  now  be  done,  with  proper  care,  almost 
in  every  instance,  with  the  aid  of  the  micro- 
scope. Dr.  Thomas  M.  Drysdale,  availing 
himself  of  the  great  opportunities  afforded  by 
Dr.   Atlee's    operations,    has,    after   numerous 


496  MEMORIAL  SERVICES. 

examinations,  satisfied  himself  of  the  existence, 
in  all  innocent  forms  of  ovarian  cysts,  of  what 
he  calls  the  "ovarian  granule  cells."  These 
cells,  which  are  very  small  and  of  a  rounded  or 
oval  shape,  are  largely  supplied  with  nuclei  and 
nucleoli,  and,  as  they  are  not  present  in  any 
other  affections  or  in  dropsical  fluids,  they  may 
be  regarded  as  characteristic.  More  recently 
Dr.  Foulis,  of  Edinburgh,  and  Dr.  Knowsley 
Thornton,  of  London,  have  ascertained  that 
malignant  ovarian  tumors  can  be  distinguished 
from  benign  ovarian  growths  by  the  presence 
of  groups  of  large,  pear-shaped,  round,  or  oval 
cells,  occupied  by  granular  material  with  nuclei, 
nucleoli,  vacuoles,  or  transparent  globules. 
The  value  of  these  researches,  in  which  Dr. 
Drysdale  has  taken  the  lead,  cannot,  in  a 
diagnostic  point  of  view,  be  overestimated,  for 
they  clearly  indicate  the  necessity,  in  every 
case  of  doubt,  of  making  a  thorough  examina- 
tion of  the  contents  of  these  classes  of  tumors 
before  finally  deciding  upon  the  propriety  of 
using  the  knife. 

The  brilliant  success  which  has  attended 
ovariotomy  both  in  America  and  in  Europe  has 
led  to  an  extension  of  the  whole  domain  of 
abdominal  surgery,  and  has  emboldened  ope- 


DEDICA  TOR  Y  ADDRESS.  ^y 

rators  to  invade  other  regions  of  the  body 
until  recently  regarded  as  too  sacred  to  be 
meddled  with.  Indeed,  there  would  seem  to 
be  hardly  any  longer  any  forbidden  territory. 
The  uterus,  the  spleen,  and  the  kidneys  have 
of  late  years  been  the  coveted  objects  of  the 
surgeon's  cupidity.  Very  lately  the  gall-bladder 
has  not  only  been  aspirated  for  the  purpose  of 
relieving  it  of  distending  fluids,  but  actually,  in 
several  instances,  extirpated.  Many  years  ago, 
during  my  residence  in  Kentucky,  I  received  a 
telegram  from  a  distinguished  surgeon  of  Co- 
lumbus, Ohio,  saying  he  had  just  excised  the 
liver,  and  that  as  his  patient  was  progressing 
favorably  he  indulged  great  hope  of  her  re- 
covery. The  woman,  however,  died  the  next 
morning,  when  it  was  discovered  that,  instead 
of  the  liver,  only  an  ovary  had  been  removed, 
thus  depriving  my  friend  of  the  glory  of  being 
a  pioneer  in  hepatic  surgery!  Within  the  last 
ten  years  a  number  of  cases  of  excision  of  the 
larynx  have  been  reported,  including,  in  some 
instances,  portions  of  the  tongue  and  of  the 
oesophagus,  and  yet  despite  the  mutilation  some 
of  the  survivors,  with  the  aid  of  an  artificial 
substitute,  articulated  nearly  as  well,  it  would 

seem,    as    before    the    operation.     The    entire 
32 


4g3  memorial  services. 

tongue,  too,  has  on  a  number  of  occasions — 
perhaps  in  not  less  than  forty  or  fifty  cases — 
been  extirpated  with,  as  is  alleged,  very  little 
impairment  of  the  patient's  voice  or  power  of 
speech.  With  such  inroads,  such  innovations, 
on  the  part  of  surgery,  we  need  not  be  sur- 
prised if,  on  waking  some  morning,  we  should 
find  the  papers  filled  with  accounts  of  the  suc- 
cessful amputation  of  the  head  without  any 
serious  detriment  to  the  patient's  mental 
faculties,  despite  the  assertion  of  Mons.  Blan- 
din,  a  French  surgeon,  that  this  portion  of  the 
body,  which  he  invariably  designates  as  the 
encephalic  extremity,  cannot  be  removed  dur- 
ing life  without  stopping  respiration  and  caus- 
ing other  inconveniences  which,  unhappily, 
render  the  operation  inadmissible  !  This  lan- 
guage, however,  it  must  not  be  forgotten,  was 
uttered  fifty  years  ago,  when  surgery  was  in  a 
comparatively  crude  condition,  and  is  therefore 
hardly  applicable  at  the  present  day.  But, 
pleasantry  aside,  as  perhaps  unbecoming  the 
occasion,  while  I  have  always  been  a  friend  to 
progress,  it  is  evident  that  there  must  be  limits 
to  the  use  of  the  knife.  What  the  fate  of  some 
of  these  operations  may  be,  whether  any  or  all 
of  them  will   be   ultimately  admitted   into   the 


DEDICA  TOR  Y  ADDRESS. 


499 


domain  of  legitimate  surgery,  must  for  the 
present  remain  an  open  question.  We  are  no 
more  justified  now  in  condemning  what  may 
seem  to  us  to  be  an  improper  operation  than 
physicians  were  in  the  days  of  McDowell  in 
condemning  ovariotomy.  Experience  alone 
can  determine  how  far  the  knife  shall  go  or 
shall  not  go. 

What  has  been  called,  perhaps  oddly  enough, 
normal  ovarioto7ny,  an  operation  first  performed 
by  Dr.  Robert  Battey,  of  Georgia,  may  be 
regarded  as  a  natural  outgrowth  of  McDowell's 
operation,  or  ordinary  ovariotomy,  rendered 
necessary,  as  is  alleged,  on  account  of  organic 
or  functional  disorder  of  the  ovaries,  incurable 
by  ordinary  treatment.  The  results  obtained 
thus  far  are  not  very  satisfactory,  and  it  is  evi- 
dent that  further  light  is  required  before  we 
can  determine  its  real  merits.  Different  me- 
thods of  reaching  the  faulty  structures  have 
been  suggested,  but  there  is  not  one  that  is 
wholly  free  from  danger,  while  that  originally 
practised  by  the  courageous  and  ingenious  in- 
ventor does  not  always  afford  sufficient  space 
for  the  purpose. 

The  statistics  of  this  operation  published  in 
1878    by    Dr.    George   J.    Engelmann,    of  St. 


coo  MEMORIAL  SERVICES. 

Louis,  embracing  forty-three  cases,  show  that 
the  risk  is  very  considerably  greater  than  in 
ordinary  ovariotomy,  fourteen  of  the  cases  ter- 
minating fatally,  while  of  the  twenty-nine  sur- 
viving patients  nine  only,  or  thirty-one  per 
cent.,  were  cured,  and  eleven  were  more  or 
less  improved.  Many  of  the  operations  were 
not  completed  on  account  of  the  impossibility  of 
extracting  the  entire  ovary. 

Dr.  Battey,  as  he  informed  me  only  a  few 
days  ago,  has  performed  this  operation  fifteen 
times  with  two  deaths  and  thirteen  recoveries. 
Of  these  thirteen  cases  four  were  promptly 
and  entirely  cured,  nine  were  benefited,  and  of 
those  not  completely  relieved  every  one  had 
made  notable  progress  during  the  last  twelve 
months. 

In  delineating  the  character  of  McDowell 
the  question  naturally  arises,  how  was  he  led  to 
perform  for  the  first  time  in  the  history  of  sur- 
gery so  dangerous  an  operation  ?  Was  it  his 
superior  knowledge  of  abdominal  and  pelvic 
diseases,  or  had  he  made  a  special  study  of 
them,  and  thus  qualified  himself  above  all  other 
men  to  become  a  pioneer  in  a  branch  of  sur- 
gery whose  territory  had  never  before  been 
invaded  by  the  knife  ?     Or  was  it  his  superior 


DEDICA  TOR  Y  A  DDR  ESS.  c  o  I 

sagacity  or  his  more  profound  penetration 
which  led  him  to  undertake  it?  Finally,  had 
the  lessons  which  as  a  student  he  imbibed  in 
the  lecture-room  during  his  sojourn  at  Edin- 
burgh any  agency  in  the  matter  ?  It  must  not 
be  forgotten,  in  discussing  this  subject,  that  long 
before  McDowell  launched  into  this  then  unex- 
plored field  of  surgery  a  number  of  distin- 
guished physicians,  in  view  of  the  hopeless 
character  of  ovarian  diseases,  suggested  their 
removal  through  an  opening  in  the  wall  of  the 
abdomen.  Among  others  who  seriously  thought 
of  the  matter  may  be  mentioned  more  especially 
the  names  of  Schlenker,  Willius,  Preger,  Cham- 
bon,  and  the  celebrated  William  Hunter,  the 
foremost  obstetrician  of  his  day  in  Great 
Britain.  None  of  these  men,  however,  had  the 
courage  to  undertake  such  an  operation.  Prior 
to  McDowell  no  surgeon  had  been  so  bold  as 
to  do  more  than  to  open  occasionally  an  ova- 
rian cyst  and  to  let  out  its  contents.  No  one 
had  dared  to  remove  an  ovarian  tumor  of  any 
kind  bodily. 

In  reflecting  upon  this  subject  I  have  always 
thought  that  the  instruction  which  McDowell 
had  received  while  attending  the  lectures  of  the 
celebrated  Mr.   John   Bell,  of  Edinburgh,  had 


CQ2  MEMORIAL  SERVICES. 

mainly  paved  the  way  to  this  undertaking.  It 
is  a  well-known  fact  that  the  young  Kentuckian 
was  greatly  impressed  by  the  lectures  of  this 
great  surgeon,  who  was  a  man  of  splendid 
genius,  of  high  intellectual  endowments,  an 
eloquent  teacher,  and  a  bold,  dashing  operator, 
then  in  the  zenith  of  his  renown.  We  may 
well  imagine  with  what  pathos  such  a  man,  a 
man  of  the  most  ardent  temperament  and  a 
most  accomplished  scholar,  would  describe 
abdominal  surgery,  and  with  what  force  and 
emphasis  he  would  dwell  upon  the  hopeless 
character  of  ovarian  tumors.  No  man,  perhaps, 
ever  taught  surgery  to  more  admiring  pupils, 
or  more  completely  fascinated  them  by  the 
power  of  his  eloquence.  There  was,  moreover, 
from  all  accounts,  a  wonderful  magnetism  about 
John  Bell,  which  drew  to  him,  as  with  an  irre- 
sistible charm,  every  one  who  came  within  his 
presence.  Listening  to  the  lectures  of  such  an 
enthusiast,  a  kind  of  Tom  Marshall  in  his  way, 
it  is  not  probable  that  the  young  American  sat 
listlessly  with  closed  eyes  and  ears  upon  the 
hard  bench  of  the  amphitheatre.  On  the  con- 
trary, his  attention  was  all  agog.  We  can  see 
him  even  now,  as  it  were,  with  open  mouth  and 
protruding  head,  with  his  chin  resting  upon  his 


DEDICA  TOR  Y  ADDRESS.  cQ3 

hands,  eagerly  drinking  in  every  word  as  it  fell 
from  the  lips  of  this  divine  son  of  yEsculapius. 
The  sparks  of  genius  which  such  a  teacher 
emits  kindle  a  flame  in  the  minds  of  his  pupils 
which  the  waters  of  all  the  rivers  and  seas  of 
the  earth  cannot  extinguish.  That  the  pre- 
lections of  this  wonderful  man  exerted  a 
powerful  influence  in  moulding  the  character  of 
McDowell  and  in  inspiring  him  with  boldness 
and  confidence  as  an  operator  is  unquestionable. 
How  far  they  affected  his  career  as  an  ovari- 
otomist  is  of  course  a  mere  matter  of  conjec- 
ture. The  knowledge  which  he  brought  home 
with  him,  and  his  warm  sympathy  for  suffering 
woman,  no  doubt  exercised  a  powerful  effect 
upon  his  future  life.  Besides,  he  was  not  un- 
aware of  the  fact  that  success  had  often 
attended  the  Csesarean  section,  and  that  persons 
not  unfrequently  recovered  after  severe  wounds 
and  other  injuries  of  the  abdominal  and  pelvic 
viscera.  Moreover,  it  is  not  improbable  that, 
in  reflecting  upon  the  subject,  he  came  to  the 
conclusion,  long  since  universally  recognized, 
that  the  peritoneum,  when  chronically  diseased, 
is  generally  comparatively  tolerant  of  the 
rudest  manipulation,  whereas  the  slightest  ex- 
posure   of,    or   interference   with,    the  healthy 


rQA  MEMORIAL  SERVICES. 

membrane  is  sure  to  be  promptly  resented, 
almost  invariably,  indeed,  at  the  expense  of  the 
patient's  life.  Finally,  it  must  not  be  forgotten 
that  McDowell  was  a  bold  surgeon,  and  a  man 
of  a  broad,  elevated  mind,  capable  of  taking  a 
comprehensive  view  of  anything  that  was  pre- 
sented to  him.  With  a  heart  as  tender  and 
gentle  as  that  of  a  woman,  he  was  not  afraid  of 
the  sight  of  blood.  For  many  years  he  had 
the  field  of  surgery  in  Kentucky  almost  wholly 
in  his  own  hands.  He  had  not  been  home  long 
from  his  foreign  residence  before  patients  began 
to  flock  to  him  from  all  parts  of  the  southwest, 
and  he  found  himself  immersed  in  a  larg^e  sur- 
gical  practice,  demanding  the  performance  not 
only  of  the  more  common  but  also  of  many  of 
the  more  difficult  and  severe  operations.  His 
first  case  of  ovariotomy  occurred  when  he  had 
hardly  been  twelve  years  engaged  in  the  prac- 
tice of  his  profession.  He  was  about  the  same 
age  as  Valentine  Mott  when  he  performed  his 
great  feat  of  tying  for  the  first  time  the  innomi- 
nate artery  ;  an  operation  in  comparison  with 
that  of  McDowell  of  utter  insignificance,  for  of 
the  nineteen  or  twenty  cases  in  which  it  has 
been  done  only  one  life  has  been  saved,  whereas 
the  other  has  already  restored  to  health  and 
comfort  upwards  of  two  thousand  women. 


DEDICA  TOR  Y  ADDRESS.  505 

The  career  of  McDowell  is  so  intimately 
bound  up  in  the  great  operation  already  so  fre- 
quently mentioned  that  one  might  suppose 
nothing  of  interest  remained  to  be  considered. 
This,  however,  is  far  from  being  the  case.  In 
many  respects,  indeed,  it  is  replete  with  inci- 
dents. Born  in  Rockbridge  County,  Virginia, 
in  1 77 1,  he  was  brought,  when  thirteen 
years  old,  by  his  parents  to  Danville,  at  a  time 
when  Kentucky  was  literally  a  wilderness,  re- 
sounding with  the  howl  of  the  panther  and  of 
the  savage  and  reeking  with  the  blood  of  its 
early  settlers.  The  terrible  battle  fought  near 
Blue  Lick  Springs,  in  which  Daniel  Boone 
played  so  conspicuous  a  part  and  lost  a  son, 
and  which  proved  to  be  so  disastrous  to  his 
followers  and  companions  in  arms,  took  place 
only  a  short  time  after  this  event,  and  filled  the 
country  with  pain  and  sorrow.  The  frequent 
wars  of  which  it  was  the  theater  gave  it  a  pecu- 
liar claim  to  the  title  of  the  "  Dark  and  Bloody 
Ground,"  from  which  it  derived  its  name.  At 
the  period  in  question  Kentucky  was  still  a  ter- 
ritory, and  it  was  not  until  after  repeated  con- 
ventions, the  last  of  which  was  held  in  this  city, 
that  it  was  finally,  in  June,  1792,  admitted  as  a 
State  into  the  Union. 


rQ6  ATE  MO  RIAL  SERVICES. 

McDowell  was  of  Scotch-Irish  parentage,  and 
the  ninth  of  twelve  children.  His  great-grand- 
father, after  whom  he  was  named,  was  Ephraim 
McDowell,  a  brave  and  courageous  man,  who, 
after  having  done  some  fighting  in  the  civil  wars 
of  Ireland,  in  the  cause  of  the  Covenanters, 
emigrated,  after  he  was  past  middle  life,  to 
Pennsylvania,  which  he  left  in  1737  for  Augusta 
County,  Virginia,  where  he  died  at  a  very  ad- 
vanced age  shortly  before  the  revolutionary 
war.  From  an  elaborate  genealogical  article 
in  the  Cincinnati  Commercial,  January  14,  1879, 
under  the  nom  de  plume  of  Keith,  it  appears 
that  the  descendants  of  the  Scotch-Irish  emi- 
grant have  become  almost  as  numerous  as  the 
sands  upon  the  sea-shore,  and  that  they  repre- 
sent by  their  intermarriages  many  of  the  most 
respectable  and  influential  families  in  Maryland, 
Virginia,  Kentucky,  Ohio,  Illinois,  Indiana,  Mis- 
souri, and  indeed  almost  in  the  entire  south- 
west. If  called  together  they  would  form,  at 
least  numerically,  a  powerful  clan.  Besides  the 
great  surgeon,  who  has  immortalized  the  family, 
many  of  these  people  have  held  important 
positions,  as  governors  of  different  States,  con- 
gressmen, lawyers,  judges,  divines,  physicians,, 
politicians,  and  army  officers.     Joseph   Nashe 


DEDICA  TOR  Y  ADDRESS. 


507 

McDowell,  who  died  only  a  few  years  ago,  was 
a  nephew  of  Ephraim,  a  great  teacher  of 
anatomy  and  surgery,  and  the  founder  of  a 
medical  school  at  St.  Louis.  Another  nephew, 
the  late  Dr.  William  A.  McDowell,  of  Louis- 
ville, occupied  a  high  position  as  a  sagacious 
and  successful  physician.  The  name  of  Gen. 
Irvine  McDowell,  United  States  Army,  is 
familiar  to  every  American  citizen.  The  father 
of  Ephraim  was  Samuel  McDowell,  an  accom- 
plished gentleman,  a  member  of  the  Legisla- 
.  ture  of  Virginia,  and,  after  his  removal  to 
Danville,  a  judge  of  the  district  court,  a  posi- 
tion which  he  held  until  within  a  short  time  of 
his  death.  On  his  mother's  side  he  was  de- 
scended from  the  McClungs,  a  distinguished 
family  of  Virginia.  The  son's  early  education 
was  obtained  at  a  classical  seminary  at  George- 
town, in  his  adopted  State,  under  the  super- 
vision of  Messrs.  Worley  and  James,  two 
accomplished  teachers.  How  long  he  remained 
here,  or  what  progress  he  made  in  his  studies, 
I  am  unable  to  say,  but  it  is  safe  to  affirm  that, 
although  he  was  fond  in  after  life  of  literary 
reading,  his  primary  education  was  sadly  neg- 
lected, and  that  he  never  surmounted  his  early 
deficiencies.     He  wrote,   as  has  already  been 


508  MEMORIAL  SERVICES. 

stated,  with  great  difficulty,  and  his  only  literary 
contributions  are  two  short  articles  contained 
in  the  Philadelphia  Eclectic  Repertory  and 
Analytical  Review  for  1817  and  18 19.  His 
medical  education  was  commenced  in  the  office 
of  an  eminent  physician,  Dr.  Humphreys,  of 
Staunton,  Virginia,  a  graduate  of  the  Univer- 
sity of  Edinburgh.  It  was  doubtless  through 
the  influence  of  his  preceptor  that  the  youth 
determined  to  go  at  once  to  the  fountain-head 
of  medical  education  and  learning,  as  the  Scotch 
metropolis  was  then  very  justly  regarded.  At 
all  events  there  is  no  proof  to  show  that  he 
ever  attended  any  lectures  in  Philadelphia,  at 
that  time  the  only  place  of  resort  for  the  medi- 
cal student  in  this  country.  The  University  of 
Edinburgh,  of  which  he  was  a  member  in  1793— 
4,  enjoyed  a  world-wide  reputation  at  this  period 
on  account  of  the  learning  and  ability  of  its 
professors,  among  whom  may  be  mentioned  as 
especially  worthy  of  notice  the  names  of  Cullen 
and  Black,  two  great  luminaries,  whose  fame 
added  lustre  to  the  school  and  attracted  pupils 
from  all  parts  of  the  civilized  world.  Not 
waiting  to  take  a  degree,  he  immediately,  upon 
his  return  to  America,  settled  at  Danville, 
where,  having  brought  with  him  the  prestige  of 


DEDICATORY  ADDRESS.  509 

foreign  study,  he  soon  acquired  the  confidence 
of  the  public  and  rapidly  rose  to  distinction  as  a 
successful  practitioner.  He  particularly  distin- 
guished himself  as  a  surgeon  and  as  an  expert 
operator,  a  position  of  which  he  retained  undis- 
puted possession  until  the  organization,  in  1819, 
of  the  medical  school  at  Lexington,  when  he 
was  gradually  eclipsed  by  his  young  rival,  Dr. 
Benjamin  Winslow  Dudley,  a  gentleman  of 
highly  fascinating  manners,  a  popular  teacher, 
and,  as  all  the  world  knows,  a  great  surgeon. 

It  is  not  the  design  of  this  address  to  enter 
into  minute  details  respecting  Dr.  McDowell's 
more  ordinary  surgical  achievements.  It  will 
subserve  my  purpose  to  state  that  he  was  an 
excellent  lithotomist,  and  that  he  repeatedly 
performed  many  of  the  great  operations  of 
surgery.  The  subject  of  one  of  these  opera- 
tions was  James  K.  Polk,  afterward  President 
of  the  United  States,  at  the  time  a  thin,  ema- 
ciated stripling,  fourteen  years  of  age,  worn 
out  by  disease,  uneducated,  and  without  appa- 
rent promise  of  future  usefulness  or  distinction. 
"As  an  operator,"  as  Dr.  Alban  G.  Smith,  who 
late  in  life  changed  his  name  to  Dr.  Goldsmith, 
and  who  knew  him  well,  having  at  one  time 
been  his  partner,  told  me,  "as  an  operator  he 


510  MEMORIAL  SERVICES. 

was  the  best  I  ever  saw  in  all  cases  in  which  he 
had  a  rule  to  guide  him  ;"  no  slight  praise  from 
a  man  who  was  himself  an  expert  operator ; 
and  yet  Dr.  Goldsmith  seemed  to  forget  that 
this  man  did  certainly  once  operate  in  a  case 
in  which  he  had  no  rule  to  guide  him,  a  case 
which  was  destined  to  confer  immortality  upon 
his  name. 

McDowell  was  not  only  a  good  operator,  but 
he  possessed  all  the  higher  attributes  which 
make  up  the  character  of  a  great  surgeon, 
intense  conscientiousness  and  a  scrupulous 
regard  for  the  welfare  of  his  patients.  He 
never  operated  merely  for  the  sake  of  operat- 
ing. He  had  always  an  eye  to  consequences. 
For  the  mere  mechanical  surgeon  he  had  an 
immitigable  contempt.  In  speaking  of  ovari- 
otomy, in  answer  to  some  strictures  pronounced 
upon  his  first  three  cases,  he  expresses  the 
hope  that  no  such  surgeon  will  ever  attempt  it. 
"It  is,"  he  adds,  "my  most  ardent  wish  that 
this  operation  may  remain  to  the  mechanical 
surgeon  for  ever  incomprehensible."  He  con- 
sidered the  profession  of  medicine  as  a  high 
and  holy  office,  and  physicians  as  ministering 
angels,  whose  duty  it  is  to  relieve  human  suffer- 
ing and  to  glorify  God.      He   had  a  warm  and 


DEDICA  TOR  J '  ADDRESS.  r  1 1 

loving  heart,  in  full  sympathy  with  the  world 
around  him.  To  the  sick  poor  he  was  particu- 
larly kind.  He  was  a  loyal  and  devoted  hus- 
band, a  tender  and  loving  father,  an  honest, 
high-toned  citizen.  In  all  the  relations  of  life 
he  was  a  model.  Naturally  of  a  lively,  social 
disposition,  he  enjoyed  a  good  joke  or  a  spicy 
anecdote,  and  was  the  delight  of  every  social 
entertainment  which  he  honored  with 'his  pres- 
ence. Late  in  life  he  devoted  much  of  his 
leisure  to  reading  and  meditation.  His  favorite 
medical  authors  were  Sydenham  and  Cullen  ; 
his  favorite  literary  authors,  Burns  and  Scott.' 
During  his  sojourn  in  Scotland  he  passed  seve- 
ral months  of  his  vacation  in  rambling-  over  the 
country  trying  to  make  himself  familiar  with 
the  nature  and  habits  of  the  peasantry.  In 
these  perambulations  he  had  the  society  of  two 
of  his  Kentucky  friends,  Drs.  Brown  and  Speed, 
the  former  of  whom  became  afterward  Pro- 
fessor of  Medicine  in  Transylvania  University. 
When  the  trio  reached  home  some  one  asked 
Brown,  "What  do  you  think  of  McDowell?" 
"  Think  of  him  ?  Why,  he  went  abroad  as  a 
gosling  and  has  come  back  as  a  goose."  It 
would  be  well  if  our  country  had  more  of  such 
birds  !     He  had  little  confidence  in  the  efficacy 


512  MEMORIAL  SERVICES. 

of  medicine,  and  constantly  cautioned  his  stu- 
dents against  the  too  free  use  of  drugs,  saying 
that  they  were  more  of  a  curse  than  a  blessing. 
He  considered  surgery  as  the  most  certain 
branch  of  the  healing  art,  and  spared  no  means 
to  extend  his  knowledge  of  it.  He  was  an 
excellent  anatomist,  and  it  is  said  that  he  never 
performed  any  serious  operation  without  pre- 
viously recalling  to  his  mind  the  structures 
involved  in  it.  In  1817  the  Medical  Society  of 
Philadelphia  sent  him  its  diploma  of  member- 
ship, and  in  1825  the  University  of  Maryland 
conferred  on  him  the  degree  of  Doctor  of 
Medicine.  At  the  age  of  thirty-one  he  married 
Sallie,  daughter  of  Gov.  Isaac  Shelby,  of  Ken- 
tucky, by  whom  he  had  six  children,  two  sons 
and  four  daughters,  two  of  the  latter  of  whom, 
Mrs.  Deadrick,  of  Tennessee,  and  Mrs.  Ander- 
son, of  Paris,  Missouri,  are  still  living  at  an 
advanced  age,  the  parents  of  large  and  highly 
respectable  families.  He  was  nearly  six  feet 
in  height,  with  a  florid  complexion,  black  eyes, 
a  commanding  presence  and  remarkable  mus- 
cular powers.  As  an  illustration  of  his  great 
physical  strength,  he  used  to  tell  with  peculiar 
o-lee  an  anecdote  of  a  circumstance  which 
occurred  while  he  attended  medical  lectures  at 


DEDICA  TOR  Y  ADDRESS.  5  1 3 

Edinburgh.     One    day,    as    the    story  goes,    a 

celebrated   Irish   foot-racer,    a    kind    of    Mike 

Fink,  arrived,  boasting  that  he  could  out-run, 

out-hop,  and  out-jump  any  man  in  the  city,  and 

bantered  the  whole  medical  class.     McDowell 

was  selected  as    their   champion,  the   distance 

being  sixty  feet,  the  stake  ten  guineas.     The 

backwoodsman  purposely  allowed  himself  to  be 

beaten.       A    second     race    for    one    hundred 

guineas,  at  an  increased  distance,  came  off  soon 

afterward,    and  this   time    the   Irishman,   after 

much  bullying,  was  badly  worsted,  much  to  his 

own  chagrin  and  the  delight  of  the  students. 

Although  McDowell's  means  were  not  large 

he  was  liberal  in  the  bestowal  of  his  charities, 

and  generous  to  a  fault  in  his  dealings  with  his 

patients.     In   1828,   only  two  years  before  his 

death,   he   united   himself  with   the    Episcopal 

Church,  of  which  he  remained  a  zealous  and 

consistent    member.       A    vein    of    piety    ran 

through   his  whole   life.     As    a    proof  of  this 

fact  it  may  be  stated  that  he  always  preferred 

to  perform  any  great  operation  that  he  might 

have  on  hand  on  the  Sabbath,  knowing,  as  he 

affirmed,  that  he  would  then  have  the  prayers 

of  the    church  with   him.     Trinity   Church   of 

Danville   was   the   special   object   of  his   care ; 
33 


cI4  MEMORIAL  SERVICES. 

and  as  an  evidence  of  the  interest  he  felt  in  it 
I  may  mention,  what  does  not  seem  to  be  gen- 
erally known  even  among  your  own  citizens, 
that  he  gave  it  the  lot  upon  which  the  present 
building  is  situated.  Indeed  McDowell,  to  use 
the  language  of  one  of  your  most  noble  and 
accomplished  women,  was  the  head  and  front 
of  its  vanguard,  which  embraced  many  dis- 
tinguished names  in  the  past  history  of  this 
portion  of  Kentucky.  Of  Center  College  he 
was  one  of  the  founders  and  original  trustees. 

Such,  fellow-citizens  of  Kentucky,  was  the 
character  of  Ephraim  McDowell ;  kind-hearted, 
benevolent,  and  just  in  all  his  dealings,  an  ex- 
cellent citizen,  an  original  thinker,  a  bold,  fear- 
less, but  most  judicious  surgeon,  and,  above  all, 
a  Christian  gentleman.  Such,  citizens  of  Dan- 
ville, was  your  former  townsman,  whose  career 
has  shed  so  much  lustre  upon  his  age  and 
country,  and  who,  if  he  could  be  in  our  midst 
this  day,  might  justly  echo  the  words  of  the 
Roman  poet,  "  Exegi  monumentum  cere  peren- 
nius." 

The  latter  years  of  this  good  man's  life  were 
clouded  by  an  attempt  made,  strange  as  it  may 
appear,  by  one  of  his  own  nephews  and  private 
pupils,  to  deprive  him  of  his  claims  as  the  origi- 


DEDICA  TOR  Y  ADDRESS.  5  T  5 

nator  of  the  operation  so  frequently  mentioned^ 
This  circumstance  induced  him,  in  1826,  only  a 
few  years  before  his  death,  to  address  a  printed 
circular  to  the  physicians  and  surgeons  of  the 
West  in  vindication  of  his  rights.  Without 
entering  into  any  particulars  respecting  this 
matter,  I  am  satisfied,  from  a  careful  examina- 
tion of  all  the  facts  connected  with  it,  that  the 
pretensions  set  up  by  this  gentleman,  were,  like 
the  "baseless  fabric  of  a  vision,"  without  the 
slightest  foundation  in  truth. 

It  was  not  given  to  McDowell  to  see  the  fruit 
of  his  labors  beyond  the  limits  of  his  own  coun- 
try ;  the  seed  which  he  sowed  fell  upon  meagre 
soil,  and  was  slow  in  germinating.  Now  and 
then,  it  is  true,  a  blossom  shot  forth  and  shed 
its  fragrance  upon  the  air,  but  fully  a  quarter 
of  a  century  elapsed  before  it  ripened  into 
vigorous  fruit.  No  single  age  has  ever  wit- 
nessed the  birth  and  the  maturity  of  any  branch 
of  human  knowledge.  McDowell  lived  in  ad- 
vance of  his  time  and  of  his  profession  ;  his 
boldness,  as  his  contemporaries  were  inclined 
to  view  his  conduct,  took  them  by  surprise,  and 
shocked  their  sensibilities ;  hence,  instead  of 
investigating  the  merits  of  his  operation,  as 
reasonable  men  should  and  would  have  done, 


516  MEMORIAL  SERVICES. 

they  rejected  it  as  the  device  of  a  crack-brained 
man,  who  deserved  to  be  prosecuted  for  a  vio- 
lation of  the  sixth  commandment.  It  was  un- 
fortunate for  McDowell  that  he  lived  at  a  time 
when  there  were  no  societies  for  the  diffusion 
of  knowledge,  and  when  the  means  of  com- 
municating intelligence  were  so  scanty  as  they 
were  in  the  early  part  of  the  present  century. 
News  at  that  period  of  our  history,  locked  up 
as  it  always  was  in  the  mail-bags  of  the  cumber- 
some four-wheeled  stage-coach,  was  often  stale 
before  it  reached  its  destination.  In  those  days, 
as  well  as  for  a  long  time  afterward,  there  were 
no  railroads,  no  steamships,  no  telegraphs.  The 
world  moved  at  a  snail-like  pace,  or,  as  it  were, 
upon  the  back  of  a  tortoise,  at  the  rate  of  six 
or  eight  miles  an  hour.  To  publish  reports  of 
medical  cases  or  of  surgical  operations  was 
then,  as  it  is  now,  unprofessional.  Besides, 
even  if  such  a  course  had  been  permissible  they 
would  have  found  their  way  very  tardily  to  the 
public.  Journalism  was  at  a  low  ebb;  there 
were  comparatively  few  newspapers,  and  news- 
paper reporters  had  no  existence.  Medical 
news  travelled  still  more  slowly  than  miscellan- 
eous. In  1817,  when  McDowell's  first  three 
cases  were  reported  in  the  Philadelphia  Medical 


DEDICA  TOR  Y  ADDRESS.  5  1 7 

Repertory  and  Analytical  Review,  there  was,  if 
I  mistake  not,  only  one  other  medical  periodi- 
cal in  the  United  States.  Had  McDowell's 
operation  been  performed  in  our  day  the  news 
would  have  spread  far  and  wide  within  the  first 
twenty-four  hours,  and  in  an  almost  incredibly 
short  time  would  have  been  carried  to  the  ut- 
most limits  of  civilization.  As  it  was,  it  was 
locked  up  first  for  eight  years  in  the  brain  of  its 
originator,  and  then  in  an  obscure  medical  jour- 
nal, and  when  at  length  it  reached  the  other 
side  of  the  Atlantic  it  met  only  with  ridicule  and 
incredulity. 

An  account  of  McDowell's  first  three  cases 
was,  it  seems,  sent  to  Dr.  Physick,  of  Philadel- 
phia, but  from  some  cause  or  other  it  failed  to 
interest  him  or  to  attract  his  attention.  He 
probably  knew  little  or  nothing  of  the  back- 
woods surgeon,  and  therefore,  it  may  be,  looked 
upon  him  as  an  adventurer  unworthy  of  notice. 
However  this  may  be,  it  fared  much  better  in 
the  hands  of  Dr.  James,  the  amiable  Professor 
of  Midwifery  in  the  University  of  Pennsylvania. 
This  gentleman,  deeply  impressed  with  the 
novelty  and  importance  of  the  subject,  and 
thoroughly  acquainted  with  the  hopeless  char- 
acter of  the  ordinary  treatment  of  ovarian  dis- 


cjg  memorial  services. 

eases,  read  an  account  of  the  cases  before  his 
class,  and  caused  it  shortly  after  to  be  published 
in  the  journal  already  several  times  referred  to, 
and  of  which,  in  fact,  he  was  one  of  the  editors. 
He,  however,  failed  to  make  any  editorial  com- 
ments upon  the  subject,  or  to  defend  the  opera- 
tion when  assailed  by  ignorant  critics.  Mc- 
Dowell also  sent  an  abstract  of  his  cases  to 
his  old  master,  Mr.  John  Bell,  but  as  this 
gentleman  had  been  for  some  time  absent  on 
the  Continent,  and  not  long  afterward  died 
at  Rome,  it  never  reached  him.  The  paper, 
however,  fell  into  the  hands  of  one  of  his  pupils, 
Mr.  John  Lizars,  of  Edinburgh,  by  whom  it  was 
published  in  the  Edinburgh  Medical  and  Sur- 
gical Journal  for  1824.  Mr.  Lizars,  as  before 
stated,  was  the  first  to  perform  McDowell's 
operation  in  Great  Britain. 

In  no  pursuit  of  life  does  history  repeat  itself 
more  frequently  than  in  affairs  relating  to  human 
progress,  innovation,  and  discovery.  From  this 
occurrence  our  profession  is  not  exempt.  The 
history  of  the  discovery  of  the  circulation  of  the 
blood,  one  of  the  most  brilliant  achievements  of 
the  human  intellect  in  the  seventeenth  century, 
is  a  striking  instance  in  point.  Of  Harvey's 
contemporaries   not  one,  it  is  said,  over  forty 


BE DIC A  TOR  Y  ADDRESS.  5  1 9 

years  of  age  accepted  his  teachings.  Many 
years  elapsed  before  the  value  of  vaccination 
was  fully  recognized,  and  even  now  an  opera- 
tion which  has  saved  millions  of  lives  has  its 
opponents  not  alone  among  the  vulgar,  but 
among  otherwise  highly  enlightened  people. 
The  use  of  the  stethoscope  as  a  means  of  diag- 
nosis was  long  rejected  by  medical  men,  and 
the  speculum,  an  instrument  as  old  as  Hercula- 
neum,  reintroduced  to  the  notice  of  the  profes- 
sion less  than  fifty  years  ago  by  Recamier,  of 
Paris,  met  with  no  better  fate.  Everybody 
knows  with  what  suspicion  many  physicians 
regarded  the  employment  of  anaesthetics,  and 
it  is  fair  to  say  that  much  prejudice  in  regard 
to  the  use  of  this  class  of  remedies  still  lingers 
in  the  public  mind.  Ignorance,  superstition, 
and  prejudice  have  ever  been  giants  in  the  path 
of  progress. 

The  idea  of  erecting-  a  monument  to  the 
memory  of  Dr.  McDowell  originated  with  one 
of  the  citizens  of  Danville,  the  late  lamented 
Dr.  John  D.  Jackson,  a  gentleman  whose  death, 
a  few  years  ago,  in  the  prime  of  life,  threw  a 
whole  community  into  mourning,  and  whose 
memory  will  long  be  cherished  on  account  of 
his  varied  accomplishments  as  a  physician,  his 


c2o  MEMORIAL  SERVICES. 

lovable  character  as  a  man,  and  the  many 
amiable  impulses  of  his  great  heart.  This  idea 
was  in  due  time  communicated  to  the  Kentucky 
State  Medical  Society,  of  which  Dr.  Jackson 
was  a  prominent  member,  and  acted  upon 
through  a  committee  whose  duty  it  became  to 
collect  the  necessary  funds  for  carrying  out  the 
noble  design.  This  committee  made  known 
its  wishes  not  only  to  the  profession  of  this 
country,  but  to  our  brethren  in  Europe,  and 
also,  if  I  mistake  not,  to  the  women  who  had 
been  the  fortunate  recipients  of  the  fruits  of 
Dr.  McDowell's  operation  :  Finally,  in  1875,  a 
stirring  appeal  was  made  to  the  American 
Medical  Association  at  its  annual  meeting  at 
Louisville  in  May  of  that  year.  From  none  of 
these  sources,  however,  was  any  substantial  aid 
derived,  and  it  devolved  at  last  upon  the  society 
in  which  the  design  originated  to  furnish  nearly 
the  entire  sum  necessary  to  carry  it  into  execu- 
tion.1 

1  All,  in  fact,  that  the  American  Medical  Association  did  was 
to  pass  an  empty  resolution,  leaving,  as  the  illustrious  chairman, 
Dr.  J.  Marion  Sims,  expressed  it,  "  to  Kentucky  the  grateful 
privilege  of  providing  a  local  monument  to  the  memory  of  Dr. 
McDowell,"  and  requesting  the  Association  to  contribute 
through  its  individual  members  the  sum  of  ten  thousand 
dollars   as   a  fund,    to   be   called  the   "  McDowell   Memorial 


DEDICA  TOR  Y  ADDRESS.  r  2  j 

While,  therefore,  the  granite  shaft  which 
graces  yonder  cemetery  is  a  just  tribute  to  the 
memory  of  a  great  and  good  man,  whose  title 
to  immortality  is  well  founded,  let  us  not  forget 
the  part  borne  in  its  erection  by  the  Kentucky 
Medical  Society,  which  had  the  sagacity  to  per- 
ceive, and  the  liberality  to  execute,  a  design 
which  reflects  so  much  credit  upon  the  medical 
profession  and  the  State  of  Kentucky.  I  feel 
a  just  pride  when  I  recall  the  fact  that  I  was 
one  of  the  founders  of  a  society  which  now 
includes  among  its  members  nearly  all  the 
medical  talent,  culture,  and  refinement  of  the 
State,  and  which  has  established  a  reputation 
for  ability,  learning,  and  enterprise  not  ex- 
ceeded by  any  similar  association  in  the  United 
States.  Dr.  McDowell  is  not  the  only  physi- 
cian of  whom  Kentucky  has  reason  to  be 
proud.  She  furnished  the  first  case  of  hip-joint 
amputation  on  this  continent  in  the  hands  of 
Dr.  Walter  Brashear,  of  Bardstown,  of  lithot- 
rity  in  the  practice  of  Dr.  Alban  G.  Smith,  of 
Danville,    and    the    most   flattering   results    in 

Fund,"  to  be  devoted  to  the  payment  of  prizes  for  the  best 
essays  relating  to  the  diseases  and  surgery  of  the  ovaries.  This 
fund  is  still  unborn,  and  it  is  not  probable  that  it  will  receive 
any  further  attention  from  the  Association. 


^ 22  MEMORIAL  SERVICES. 

ovariotomy  in  the  hands  of  Dr.  J.  Taylor  Brad- 
ford, of  Augusta.  The  triumphs  of  Dr.  Benja- 
min W.  Dudley  in  lithotomy  established  for 
him  an  unrivalled  reputation  in  his  day  as  a 
great  operator  in  calculous  affections.  Her 
medical  teachers  were  for  a  long  time,  as  they 
still  are,  among  the  foremost  in  the  land,  and 
it  is  but  just  to  say  that  her  practitioners  have 
nowhere  any  superiors.  Kentucky  was  the 
first  State  west  of  the  Allegheny  Mountains  to 
establish  a  medical  school  and  to  send  forth  its 
first  medical  graduate  in  the  West.  If  in  state- 
manship  she  may  boast  of  a  Clay  and  of  a  "  sil- 
ver-tongued" Crittenden,  whose  eloquence  en- 
chained admiring  audiences,  and  elicited  the 
applause  of  the  senate  chamber  ;  if  her  bar  was 
long  known  as  one  of  the  most  elegant,  astute, 
and  learned  in  the  land ;  if  her  pulpit  was 
dignified  by  the  piety,  erudition,  and  oratory  of 
her  Campbells  and  her  Breckinridges,  and  is 
still  adorned  by  her  Humphreys,  her  Robin- 
sons, and  other  great  divines,  she  has  their 
counterparts  in  her  Caldwell,  her  Drake,  her 
Dudley,  her  Miller,  her  Rogers,  her  Yandell, 
her  Bush,  and  other  great  physicians  whose 
names  stand  high  upon  the  roll  of  fame,  and 
who,   if  they  had    directed   their   attention   to 


DED1CA  TOR  Y  ADDRESS. 


52; 


other  pursuits,  would  have  been  equally  dis- 
tinguished. These  men  need  no  monuments 
to  perpetuate  their  virtues  or  their  services  ; 
their  names  live  in  the  esteem  and  affection  of 
their  fellow-citizens,  engraved  in  good  acts,  de- 
signed to  relieve  human  suffering  and  to  exalt 
the  dignity  of  human  nature. 

I  stop  here  for  a  moment  to  ask,  What  is  the 
object  of  a  monument?  Is  it  to  glorify  the 
dead  or  to  encourage  the  living?  The  boy,  as 
he  passes  along  Charles  Street,  Baltimore, 
under  the  shadow  of  the  Washington  monu- 
ment, pauses  to  read  the  inscription  upon  its 
entablature:  "Erected  by  the  State  of  Mary- 
land in  grateful  recognition  of  the  virtues  and 
services  of  the  'Father  of  his  Country.'  "  He 
gazes  at  the  august  figure  at  the  top,  and  dis- 
covers in  it  all  the  attributes  of  a  great  man  ;  he 
goes  home  and  curiosity  impels  him  to  inquire 
into  his  character  ;  perhaps  he  consults  his 
childish  history,  and  there  finds  that  Washing- 
ton, the  grandest  subject  of  all  history,  was  the 
saviour  of  his  country ;  like  himself,  at  one 
time,  an  obscure  youth,  but  now,  long  after  his 
death,  the  idol  of  the  American  people.  He 
has  learned  an  important  lesson  ;  his  ambition 
is  roused ;  his  energies    have  received  a  new 


e24  MEMORIAL  SERVICES. 

impulse  ;  in  a  word,  new  life  has  been  infused 
into  his  soul,  and  that  boy  is  already  the  com- 
ing man.  The  granite  shaft  which  we  have  this 
day  dedicated  to  the  memory  of  McDowell  is  a 
living  biography,  designed  not  merely  to  com- 
memorate the  virtues  and  services  of  a  great 
and  good  man,  but  to  excite  the  emulation  of 
Kentucky's  youths  and  to  urge  them  on  to 
deeds  of  valor  and  of  humanity.  A  country 
without  monuments  is  a  country  without  civili- 
zation. 

I  cannot  forbear  introducing  here  the  appro- 
priate and  beautiful  remarks  of  an  old  and  dis- 
tinguished pupil,  Dr.  David  W.  Yandell,  made 
upon  a  recent  festive  occasion,  when  contrast- 
ing the  fame  of  the  statesmen,  the  orators,  and 
the  military  men  of  Kentucky  with  that  of 
McDowell.  "  Chief  among  all  these,''  says  my 
eloquent  friend,  "  is  he  who  bears  the  mark  of 
our  guild,  Ephraim  McDowell ;  for  the  labors 
of  the  statesman  will  give  way  to  the  pitiless 
logic  of  events,  the  voice  of  the  orator  grow 
fainter  in  the  coming  ages,  and  the  deeds  of 
the  soldier  eventually  find  place  only  in  the 
library  of  the  student  of  military  compaigns ; 
while  the  achievements  of  the  village  surgeon, 
like  the  widening  waves  of  the  inviolate  sea, 


DEDICA  TOR  Y  ADDRESS.  525 

shall  reach  the  uttermost  shores  of  time,  hailed 
by  all  civilizations  as  having  lessened  the  suffer- 
ing and  lengthened  the  span  of  human  life." 

In  selecting-  Danville  for  the  site  of  the 
"McDowell  Monument"  the  Kentucky  State 
Medical  Society  made  a  happy  choice,  for  it 
was  here  that  the  Father  of  Ovariotomy  encoun- 
tered and  vanquished  his  early  professional 
struggles;  here  that  he  performed  his  great 
achievements  ;  here  that  at  the  close  of  a  well- 
spent  life  he  was  laid  quietly  in  the  grave. 
When  McDowell,  after  his  return  from  Europe, 
began  the  practice  of  medicine  here,  Danville 
contained  a  mere  handful  of  inhabitants  ;  but 
he  soon  identified  himself  with  its  prosperity, 
watching  its  progress  with  a  jealous  eye,  and 
contributing  largely  by  his  means  and  his  good 
sense  to  make  it  what  it  now  emphatically  is,  the 
Athens  of  the  West,  a  distinction  at  one  time 
so  justly  conceded  to  her  near  neighbor  Lex- 
ington. Its  institutions  of  learning  have  be- 
come the  foremost  in  the  State.  Center  Col- 
lege has  educated  many  of  Kentucky's  greatest 
citizens.  Its  theological  school  has  widely  dis- 
seminated the  lessons  of  Christianity.  Its 
female  seminaries  have  planted  the  seeds  of 
virtue,  piety,  and  learning  in    the    hearts  and 


c26  MEMORIAL  SERVICES. 

minds  of  her  young  women.  The  institution 
for  the  education  of  deaf-mutes  was  the  first  of 
the  kind  established  in  the  West.  Founded  in 
1823,  shortly  after  those  at  Hartford,  Philadel- 
phia, and  New  York,  it  gradually,  despite 
great  obstacles,  attained,  under  the  wise  man- 
agement and  fostering  care  of  the  late  Mr. 
John  A.  Jacobs,  extending  over  a  period  of 
forty-four  years,  a  degree  of  reputation  not  less 
creditable  to  the  country  at  large  than  to  his 
adopted  State.  His  death  in  1869  was  a  public 
loss,  widely  deplored. 

Nearly  forty  years  have  elapsed  since  I  was 
called  to  the  chair  of  surgery  in  the  University 
of  Louisville,  and  responded,  along  with  Pro- 
fessor Drake,  at  the  request  of  my  colleagues, 
to  an  invitation  issued  by  the  late  Dr.  William 
L.  Sutton,  of  Georgetown,  to  assist  in  forming 
a  State  medical  society.  The  first  attempt 
proved  abortive,  but  another,  made  under  more 
favorable  auspices  several  years  later,  was  suc- 
cessful, and  the  society  soon  assumed  import- 
ant proportions.  Of  the  original  members,  of 
whom  Dr.  Sutton  was  one  of  the  most  zealous 
and  influential,  few  survive  ;  but  it  is  gratifying 
to  know  that  the  work  which  they  inaugurated 
has  been  so  nobly  pushed  forward  by  their  sue- 


DEDICA  TOR  Y  ADDRESS.  5  2J 

cessors,  not  a  few  of  whom  have  achieved  a 
wide  and  enduring  reputation  as  medical  phi- 
losophers, clear  thinkers,  accurate  observers, 
and  accomplished  and  sagacious  practitioners. 
If  any  evidence  were  needed  of  their  zeal  to 
advance  the  interests  of  medical  science  and  of 
suffering  humanity,  it  would  be  found,  not  in 
idle  talk  or  vapid  boasting,  but  in  hard  work 
and  steady  and  persistent  effort,  as  shown  in 
the  transactions  of  their  society  and  in  our 
periodical  literature.  Progress  of  the  most 
laudable  character  is  everywhere  visible  in  its 
ranks.  Since  the  period  adverted  to  most  of 
my  earlier  Kentucky  friends  in  and  out  of  the 
profession  have  passed  away,  while  of  my 
earlier  colleagues  in  the  University  of  Louis- 
ville not  one  remains.  Drake  and  Caldwell 
and  Short  and  Cobb  and  Miller  and  Yandell 
have  gone  to  their  last  home,  to  that  sleep  which 
knows  no  waking.  Palmer  and  Rogers,  who 
entered  the  school  at  a  later  day,  have  also 
been  gathered  to  their  fathers  ;  the  one  a  bril- 
liant anatomical  teacher  and  a  genial  and  intel- 
ligent companion ;  the  other  for  upward  of  a 
third  of  a  century  Louisville's  honored,  be- 
loved, and  favorite  physician,  with  a  heart 
gentle  as  a  woman's  and  a  countenance  benig- 


C28  MEMORIAL  SERVICES. 

nant  as  an  angel's.  Kentucky  has  a  long  list 
of  deceased  physicians,  who  have  left  behind 
them  a  rich  legacy  and  an  example  worthy  of 
the  emulation  of  their  successors,  whose  duty 
it  should  be  to  cherish  their  memories  and  to 
transmit  to  their  descendants  the  history  of 
their  lives. 

It  would  be  unjust  alike  to  the  occasion,  as  it 
would  be  to  my  own  feelings  if  I  failed  to  con- 
nect with  each  other  and  with  the  great  ovari- 
otomist,  as  with  an  adamantine  chain,  the 
names  of  those  of  our  surgeons,  already  seve- 
ral times  mentioned,  who  have  been  instrumen- 
tal in  reviving  this  operation  in  this  country, 
and  thus  giving  it  a  new  impulse.  The  names 
which  stand  most  conspicuously  upon  this 
honored  list  are  those  of  the  two  brothers 
Atlee,  John  and  Washington,  J.  Taylor  Brad- 
ford, Edmund  Randolph  Peaslee,  Gilman  Kim- 
ball, and  Alexander  Dunlap.  Of  these  six 
pioneers  in  this  field  of  surgery  three  have 
passed  away,  while  the  other  three,  John  L. 
Atlee,  Gilman  Kimball,  and  Alexander  Dunlap, 
are  still  spared  to  us,  in  a  ripe  but  vigorous 
old  age,  to  battle  with  disease  and  death  and  to 
earn  additional  laurels  for  themselves  and  their 
country. 


DEDICA  TOR  Y  ADDRESS.  5  29 

Of  the  early  life  of  Dr.  J.  Taylor  Bradford, 
who  died  a  number  of  years  ago  in  the  prime 
and  vigor  of  life,  I  know  nothing,  although  our 
acquaintance  extended  over  a  period  of  twenty 
years.  He  received  his  medical  degree  from 
the  University  of  Louisville  during  the  early 
part  of  my  connection  with  that  institution,  and, 
settling  at  Augusta  immediately  afterward,  soon 
acquired  a  large  and  commanding  practice,  per- 
forming many  important  surgical  operations, 
and  earning  an  enviable  reputation  as  a  most 
successful  ovariotomist.  Had  he  reached  the 
age  usually  allotted  to  man  his  cases  would 
probably  have  been  counted  by  the  hundred. 

Dr.  Washington  L.  Atlee,  who  died  at  his 
home  in  Philadelphia  in  September,  1878,  was, 
as  is  his  brother  John,  a  native  of  Lancaster, 
Pennsylvania,  where  he  was  born  in  February, 
1808.  After  having  received  an  academic 
education  he  graduated  at  the  Jefferson  Medi- 
cal College  in  1829.  Having  been  fellow- 
students  in  the  office  of  Professor  George  Mc- 
Clellan,  the  eminent  surgeon,  and  having  met 
with  him  very  frequently  after  my  removal  to 
Philadelphia  in  1856,  I  had  excellent  opportuni- 
ties of  forming  a  correct  estimate  of  his  charac- 
ter, which  no  one  perhaps  appreciated  more 
34 


c-jq  MEMORIAL  SERVICES. 

fully  than  myself.  If  this  character  was  not 
perfect  in  the  true  sense  of  that  term  it  was  a 
model  worthy  of  universal  imitation.  He  had 
many  striking  traits  of  character,  with  a  strong, 
vigorous  mind  incased  in  a  strong  body,  and 
accomplished  a  vast  deal  of  work.  He  per- 
formed a  much  greater  number  of  professional 
journeys  than  ever  fell  to  the  lot  of  any  Ameri- 
can physician.  His  visits  extended  into  almost 
every  State  of  the  Union  and  even  into  a  num- 
ber of  our  Territories.  His  power  of  endur- 
ance was  gigantic.  He  often  travelled  thous- 
ands of  miles  without  taking  any  rest  except 
such  as  he  found  upon  the  swiftly-flying  railway 
train.  Not  unfrequently  he  performed  two 
ovariotomy  operations  on  the  same  day.  Such 
labor  could  not  fail  to  make  serious  inroads 
upon  the  stoutest  frame,  and,  although  the  day 
of  reckoning  was  long  put  off,  it  was  sure  to 
come  at  length. 

The  early  professional  life  of  Atlee  was  spent 
in  earnest  practice,  enlivened  by  the  study  of 
botany  and  other  branches  of  natural  science, 
for  which  he  had  a  great  fondness.  Much  of 
his  leisure  during  the  first  few  years  was  spent 
among  the  flowers  and  grasses  of  his  native 
county.     After  his  removal,  in   1844,  to  Phila- 


DEDICA  TOR  Y  ADDRESS. 


531 


delphia  he  occupied  for  eight  years  the  chair 
of  chemistry  in  what  was  then  known  as  the 
Pennsylvania  Medical  College.  His  career  as 
an  ovariotomist  began,  as  already  stated,  in 
1844  and  terminated  only  with  his  life.  His 
first  case  proved  fatal.  As  an  operator  in  his 
specialty  he  had  no  superior  on  this  continent, 
if  indeed  anywhere.  Despising  display,  always 
so  well  calculated  to  entrap  the  vulgar,  he  em- 
ployed the  fewest  possible  instruments  and 
went  about  his  work  calmly  and  deliberately, 
with  the  greatest  care  for  the  welfare  of  his 
patient,  which,  it  is  safe  to  say,  no  man  had 
ever  more  at  heart.  There  was  no  hurry,  no 
parade,  no  ostentation.  I  witnessed  a  number 
of  his  operations  and  was  strongly  impressed 
by  the  simplicity  of  his  movements  and  the 
coolness  of  his  manner.  Such,  in  a  few  words, 
was  his  character  as  an  operator.  But  it  must 
not  be  inferred  that  Dr.  Atlee  was  a  mere  spe- 
cialist. For  many  years  he  enjoyed  a  large 
and  lucrative  general  practice,  although  during 
the  last  quarter  of  a  century  of  his  life  his  busi- 
ness was  mainly  in  the  direction  of  abdominal 
surgery,  in  which  he  achieved  an  enduring 
reputation.  He  wrote  largely  for  the  medical 
press,   and  late  in  life  published   an   able  and 


532  MEMORIAL  SERVICES. 

elaborate  treatise  on  the  Diagnosis  of  Ovarian 
Tumors,  a  subject  which  he  invested  with  new 
light.  His  operation  for  the  removal  of  fibroid 
growths  of  the  uterus  constitutes  a  new  era  in 
surgery,  precious  alike  to  science  and  to  hu- 
manity. Like  McDowell's  operation,  Atlee's 
was  received  with  distrust,  and  remained  un- 
appreciated for  upward  of  a  quarter  of  a  cen- 
tury. Time,  however,  which  generally  meas- 
ures things  according  to  their  real  value,  has 
made  a  strong  verdict  in  its  favor,  and  it  is 
therefore  not  surprising  that  the  gynecologists 
of  America  and  Europe  should  unite  in  pro- 
claiming it  as  one  of  the  greatest  achievements 
of  modern  surgery.  Atlee's  own  successes 
should  have  been  quite  sufficient  to  convince 
any  unprejudiced  mind  of  its  great  value. 

Atlee  had  a  strong  but  tender,  sympathizing 
heart,  a  well-regulated  temper,  a  high  sense  of 
honor,  and  a  clear  and  well-cultivated  mind. 
Tall  and  erect  in  person,  he  had  a  commanding 
presence,  blended  with  the  air  and  graces  of 
the  well-bred  gentleman.  In  the  sick-room  he 
was  cheerful  and  winning  in  his  manners,  with 
a  heart  full  of  kindly  feeling  for  the  sufferer. 
He  was  the  idol  of  his  family,  a  warm  friend,  a 
loyal  citizen,  a  consistent  Christian.     His  last 


DEDICA  TOR  Y  ADDRESS.  c  3  3 

illness,  extending  over  a  period  of  three  months, 
was  cruelly  severe,  but  he  bore  his  suffering, 
which  was  daily  making  sad  inroads  upon  his 
previously  robust  frame,  without  a  murmur  of 
complaint  or  impatience.  The  gradual  decay 
of  his  body  did  not  impair  his  intellectual 
powers,  and  his  mind  remained  clear  to  the 
last.  No  man,  perhaps,  ever  set  his  house 
more  perfectly  in  order  than  he  did  ;  not  even 
the  most  minute  details  were  overlooked.  Im- 
partial history  will  assign  to  Washington  L. 
Atlee  a  high  rank  in  the  temple  of  fame  as  an 
original  thinker,  an  accomplished  surgeon  and 
physician,  and  a  benefactor  of  his  race. 

Dr.  Edmund  Randolph  Peaslee,  whose  name, 
as  has  been  stated,  is,  like  that  of  Atlee,  so 
honorably  associated  with  the  progress  of 
ovariotomy  in  this  country,  died  in  January, 
1878,  only  about  eight  months  before  his  dis- 
tinguished Philadelphia  confrere.  Born  in  New 
Hampshire  in  1814,  he  was  emphatically  a 
many-sided  man,  of  high  culture,  great  refine- 
ment, vast  industry,  and  extraordinary  pro- 
fessional resources  in  cases  of  emergency. 
With  the  exception  of  Nathan  Smith,  of  New 
Haven,  a  contemporary  of  McDowell,  I  have 
no  recollection  of  any  man  who  in  recent  times 


--a  MEMORIAL  SERVICES. 

;>o4 

lectured  on  so  many  branches  of  medical  sci- 
ence or  filled  chairs  in  so  many  medical  schools. 
Anatomy  and  physiology,  general  pathology, 
surgery,  obstetrics,  and  gynecology  were  the 
diversified  themes  which  from  time  to  time 
engaged  his  facile  brain  as  a  public  teacher. 
He  was  also  an  expert  and  cautious  operator 
and  a  most  accomplished  physician,  especially 
distinguished  for  his  skill  as  a  diagnostician. 
Besides  numerous  papers  contributed  to  the 
periodical  press,  he  was  the  author  of  several 
books ;  among  others  an  exhaustive  treatise  on 
Ovarian  Tumors,  published  in  1872,  a  pro- 
duction which,  while  it  greatly  enhanced  his 
reputation  at  home,  made  his  name  widely 
known  abroad.  Of  his  operations  I  have 
already  spoken.  The  private  character  of  Dr. 
Peaslee  may  be  best  summed  up  in  the  beau- 
tiful words  of  his  biographer,  the  Rev.  Dr. 
Bartlett,  President  of  Dartmouth  College,  who, 
having  known  him  long  and  well,  thus  speaks 
of  him:  "His  day,"  says  this  accomplished 
scholar,  "is  done;  his  sun  is  set.  But  from 
the  scene  of  its  setting  there  streams  up  a  trail- 
ing brightness,  as  of  some  perpetual  zodiacal 
light — the  shining  example  of  one  who,  while 
profound  in  science,  wise  in  counsel,  and  ex- 


DEDICA TORY  ADDRESS.  535 

cellent  in  skill,  was  also  sincere  in  piety,  blame- 
less in  manhood,  true  in  friendship,  genial  in 
intercourse,  and  whose  presence  enters  the 
sick-chamber  like  a  sunbeam  from  heaven 
streaming  into  a  darkened  room.  Its  mild 
radiance  lingers  in  hundreds  of  homes  and 
thousands  of  hearts.  It  is  a  life  profitable  for 
young  men  to  contemplate." 

Young  men  of  the  Kentucky  State  Medical 
Society,  listen  to  the  voice  of  one  who  has 
grown  old  in  his  profession,  and  who  will  prob- 
ably never  address  you  again,  as  he  utters  a 
parting  word  of  advice.  The  great  question  of 
the  day  is,  not  this  operation  or  that,  not  ovari- 
otomy or  lithotomy,  or  a  hip-joint  amputation, 
which  have  reflected  so  much  glory  on  Ken- 
tucky medicine  ;  but  it  is  preventive  medicine, 
the  hygiene  of  our  persons,  our  dwellings,  our 
streets  ;  in  a  word,  our  surroundings,  whatever, 
and  wherever  they  may  be,  whether  in  city, 
town,  hamlet,  or  country,  and  the  establishment 
of  efficient  town  and  State  boards  of  health, 
through  whose  agency  we  shall  be  the  better 
able  to  prevent  the  origin  and  fatal  effects  of 
what  are  known  as  the  zymotic  diseases,  which 
carry  so  much  woe  and  sorrow  into  our  families, 
and  which  often  sweep,  like  a  hurricane,  over 


r,6  MEMORIAL  SERVICES. 

the  earth,  destroying  millions  of  human  lives  in 
an  incredibly  short  time.  The  day  has  arrived 
when  the  people  must  be  roused  to  a  deeper 
and  more  earnest  sense  of  the  people's  welfare, 
and  when  suitable  measures  must  be  adopted 
for  their  protection  as  well  as  for  the  better 
development  of  their  physical,  moral,  and  intel- 
lectual powers.  This  is  the  great  problem  of 
the  day,  the  question  which  you,  as  representa- 
tives of  the  rising  generation  of  physicians, 
should  urge,  in  season  and  out  of  season,  on 
the  attention  of  your  fellow-citizens  ;  the  ques- 
tion which,  above  all  and  beyond  all  others, 
should  engage  your  most  serious  thoughts  and 
elicit  your  most  earnest  cooperation.  When 
this  great,  this  mighty  object  shall  be  attained  ; 
when  man  shall  be  able  to  prevent  disease  and 
to  reach  with  little  or  no  suffering  his  three- 
score years  and  ten,  so  graphically  described 
by  the  Psalmist,  then,  but  not  till  then,  will  the 
world  be  a  paradise,  with  God,  Almighty,  All- 
wise,  and  All-merciful,  in  its  midst,  reflecting 
the  glory  of  His  majesty  and  power,  and  hold- 
ing sweet  converse  in  a  thousand  tongues  with 
the  human  family. 


ADDRESS    OF    PROFESSOR   SAYRE. 


No  word  from  me  can  add  a  single  laurel  to 
the  crown  of  the  immortal  McDowell,  whose 
history  and  services  to  mankind  have  been  so 
beautifully  and  truthfully  portrayed  by  the  dis- 
tinguished orator  of  the  evening,  the  Nestor  of 
American  surgery,  Prof.  Gross.  In  fact,  any 
remarks  from  me  in  my  individual  capacity 
would  seem  almost  inappropriate,  but  in  my 
official  capacity  as  President  of  the  American 
Medical  Association  it  is  my  duty  as  well  as  my 
pleasure  to  bring  to  the  monumental  shrine  the 
ovations  of  the  entire  medical  profession  of 
these  United  States.  And,  Sir,  I  venture  here 
the  prediction  that  in  all  time  to  come  the 
intelligent  surgeons,  either  in  person  or  in 
thought,  from  every  part  of  the  civilized  globe, 
will  wander  here  to  Danville  to  pay  their 
respects  and  sense  of  obligation  to  the  memory 
of  Ephraim  McDowell,  who  has  contributed 
more  to  the  alleviation  of  human  suffering  and 
the  prolongation  of  human  life  than  any  other 

(537) 


c,g  MEMORIAL  SERVICES. 

member  of  the  medical  profession  in  the  nine- 
teenth century.  We  can  scarcely  comprehend 
the  greatness  of  this  man's  mind,  and  the  truly 
wonderful  genius  of  McDowell,  until  we  stop 
to  consider  who  he  was,  what  he  did,  and  when 
and  where  he  did  it.  A  village  doctor  in  the 
backwoods  frontier,  surrounded  by  Indians  and 
the  buffalo,  almost  beyond  the  bounds  of  civili- 
zation, with  no  books  to  refer  to,  with  no  pre- 
cedent to  guide,  with  no  one  to  consult  but  his 
own  unaided  judgment,  with  no  one  to  share 
the  responsibility  if  unsuccessful,  unaided  and 
alone  assumes  the  responsibility  of  removing 
a  disease  which  up  to  that  time  had  been  con- 
sidered absolutely  incurable.  Think  for  a  mo- 
ment what  would  have  been  the  result  of  failure 
— a  coroner's  jury,  and  a  verdict  of  wilful  mur- 
der, which  at  that  time  would  have  been  pro- 
nounced correct  by  the  entire  medical  profes- 
sion throughout  the  civilized  globe.  All  this 
he  dared  and  did  assume,  because  his  clear 
intellect  had  reasoned  out  his  plan  of  proce- 
dure, and  his  careful  dissections  had  pointed 
out  to  him  the  path  to  victory.  And  now  every 
intelligent  surgeon  in  the  world  is  performing 
the  operation  as  occasion  requires,  until  at  the 
present  time,  as  Dr.  Thomas  has  stated,  forty 


ADDRESS  OF  PROFESSOR  SAYRE.  -39 

thousand  years  have  already  been  added  to  the 
sum  of  human  life  by  this  one  discovery  of 
Ephraim  McDowell. 

Another  fact  strikes  me  very  forcibly,  Mr. 
President,  and  that  is,  the  heroic  character  of 
the  woman  who  permitted  this  experimental 
operation  to  be  performed  upon  her.  The 
women  of  Kentucky  in  that  period  of  her  early 
history  were  heroic  and  courageous,  accus- 
tomed to  brave  the  dangers  of  the  tomahawk 
and  scalping-knife,  and  had  more  self-reliance 
and  true  heroism  than  is  generally  found  in  the 
more  refined  society  of  city  life  ;  and  hence  the 
courage  of  Mrs.  Crawford,  who,  conscious  that 
death  was  inevitable  from  the  disease  with 
which  she  suffered,  so  soon  as  this  village  doc- 
tor explained  to  her  his  plan  of  affording  her 
relief,  and  convinced  her  judgment  that  it  was 
feasible,  immediately  replied,  "  Doctor,  I  am 
ready  for  the  operation  ;  please  proceed  at 
once  and  perform  it." 

All  honor  to  Mrs.  Crawford  !  Let  her  name 
and  that  of  Ephraim  McDowell  pass  down  in 
history  together  as  the  founders  of  ovariotomy. 

Kentucky  has  many  things  to  boast  of  in 
climate,  soil,  and  magnificent  forests  of  oak 
carpeted  with  her  native  bluegrass,  far  surpass- 


Q0  MEMORIAL  SERVICES. 

ing  in  beauty  and  grandeur  the  most  elegantly 
cultivated  parks  of  England.  She  is  famed  for 
her  beautiful  and  accomplished  women  ;  she  is 
renowned  for  her  statesmen,  her  orators,  and 
her  jurists  ;  her  Clays,  her  Johnsons,  her  Wick- 
liffes,  her  Crittendens,  her  Marshalls,  her 
Shelbys,  her  Prestons,  her  Breckinridges,  and  a 
host  of  others  ;  but  no  name  will  add  more  to 
the  lustre  of  her  fame  than  the  one  whose 
name  we  this  day  commemorate  by  erecting 
this  monument  to  Ephraim  McDowell,  the 
ovariotomist. 


CORRESPONDENCE. 

LETTERS  FROM  DISTINGUISHED  GENTLEMEN  AND 
MEMBERS  OF  THE  PROFESSION. 

L.  S.  McMurtry,  M.D., 

Chairman  McDowell  Monument  Committee. 

My  dear  Doctor  :  With  eagerness  I  ac- 
cepted, a  few  weeks  since,  the  invitation  of  your 
committee,  and  anticipated  rare  pleasure  in 
meeting  the  many  distinguished  medical  gentle- 
men whom  the  occasion  and  the  exercises  so 
wisely  planned  for  the  dedication  of  the  monu- 
ment just  erected  at  Danville  to  the  memory 
of  Ephraim  McDowell  would  naturally  bring 
together. 

The  medical  profession  of  the  United  States, 
under  the  auspices  of  the  Kentucky  State 
Medical  Society,  has  honored  itself  in  honoring, 
by  this  special  mark  of  gratitude,  Kentucky's 
most  eminent  surgeon. 

The  purpose  of  the  meeting — a  public  and 
emphatic  indorsement  by  the  profession  of  the 
country — affirming  the  claim  of  originality  in  the 
operation  of  ovariotomy  to  Dr.  McDowell,  and 

C540 


c42  MEMORIAL  SERVICES. 

showing  a  readiness  to  recognize  and  admire 
superior  genius  in  our  ranks,  and  hold  it  up  for 
imitation  and  encouragement,  will  certainly 
meet  the  approbation  of  every  lover  of  the 
science  of  medicine. 

For  a  number  of  years  I  enjoyed  the  rare 
privilege  of  an  intimate  friendship  with  Dr. 
John  D.  Jackson,  of  Danville,  the  originator  of 
the  project  to  have  the  medical  profession  of 
America  erect  a  becoming  monument  to  Ken- 
tucky's— yes,  to  America's  great  surgeon,  Dr. 
Ephraim  McDowell,  of  Danville,  Kentucky, 
who  had  the  genius  to  devise  and  the  courage 
to  execute,  almost  without  assistance,  the  for- 
midable operation  of  ovariotomy  in  your  town. 
Well  do  I  remember  the  enthusiasm  of  Dr. 
Jackson  when  commenting  upon  this  splendid 
operation,  which  has  added  greater  security  to 
the  life  of  woman,  rendered  its  originator's 
name  imperishable,  elevated  the  character  of 
medicine  everywhere,  and  given  fame  to  Ame- 
rican surgery  throughout  the  civilized  world. 

Ovariotomy  deserves  to  rank  as  one  of  the 
four  greatest  discoveries  in  the  progess  of 
medical  science,  along  with  the  circulation  of 
the  blood,  vaccination,  and  anaesthetics. 

Besides  my  enforced  absence  I  have  but  one 


CORRESPONDENCE.  543 

regret,  which  I  doubt  not  is  felt  by  all  who  may 
be  present  with  you,  which  is  that  Dr.  Jackson 
was  not  spared  to  take  part  in  the  dedication  of 
this  noble  and  appropriate  memento  to  his 
townsman,  to  whose  memory  and  achievements 
he  was  so  ardently  attached. 

The  work  in  its  consummation  will,  I  am  con- 
fident, as  faithfully  and  imperishably  perpetuate 
the  fame  of  Jackson  as  it  does  the  name  of  the 
noble  McDowell,  for  whom  it  has  been  erected. 

Thanking  you,  gentlemen,  for  your  courtesy, 
and  regretting  more  than  I  can  express  my 
inability  to  be  present  to  testify  by  my  presence 
my  appreciation  of  your  commendable  and  so 
satisfactorily  completed  labors,  and  to  have  the 
pleasure  of  hearing  the  dedicatory  address  of 
the  veteran  American  surgeon,  Prof.  S.  D. 
Gross,  as  well  as  to  meet  old  friends  and  par- 
take of  your  hospitality  on  this  occasion, 

I  am,  with  sentiments  of  regard, 
Very  truly  yours, 

J.  M.  Toner,  M.D. 

Washington,  May  13,  1879. 


caa  MEMORIAL  SERVICES. 

L.  S.  McMurtry,  M.D., 

Chairman  McDowell  Monument  Committee. 

Dear  Doctor:  I  have  much  pleasure  in 
acknowledging  receipt  of  the  invitation  to 
attend  the  memorial  occasion  in  honor  of  "the 
Father  of  Ovariotomy."  Unfortunately  for  me 
some  professional  duties  here,  which  cannot  in 
any  way  be  postponed,  will  compel  my  return 
home  from  Atlanta  immediately  after  the  ad- 
journment of  the  American  Medical  Associa- 
tion. 

It  is  well  in  the  name  of  American  surgery, 
and  in  the  name  of  a  common  philanthropy, 
that  this  honor,  though  tardy,  should  be  paid 
to  the  memory  and  fame  of  Ephraim  McDowell. 

I  cannot  but  think  of  the  fact  that  the  erec- 
tion of  the  monument  is  largely  due  to  the 
original  suggestion  and  active  efforts  of  one 
who  recently  passed  away  from  earth  before 
he  had  reached  the  noon  of  his  power  and  repu- 
tation, one  who  was  esteemed  and  admired  by 
every  physician  North,  South,  East,  and  West. 
The  monument  will  tell  not  only  of  "  the  Father 
of  Ovariotomy,"  but  also  of  John  D.  Jackson. 
I  am,  dear  Sir,  yours  very  truly, 

Theophilus  Parvin. 

Indianapolis,  Ind.,  May  i,  1879. 


CORRESPONDENCE.  ,^ 

L.    S.    McMuRTRY,     M.D.,  AND  OTHERS, 
Of  the  McDowell  Monument  Committee. 

Gentlemen  :  Your  kind  invitation  to  attend 
the  dedication  of  the  McDowell  monument  is 
just  received,  for  which  I  beg  leave  to  return  my 
thanks,  and  the  assurance  of  my  sincere  regret 
that  I  shall  be  prevented  from  taking  part  in 
the  interesting-  ceremonies. 

The  occasion  is  one  of  extraordinary  import, 
in  that  it  is  the  first  and  only  instance  in  the 
history  of  the  United  States  that  such  honors 
have  been  paid  to  the  memory  of  a  physician ; 
and  secondly,  that  the  virtues  which  it  is  pro- 
posed to  perpetuate  in  the  monument  were 
consecrated  to  the  saving  of  human  life  and  the 
mitigation  of  human  suffering.  Of  the  man 
Ephraim  McDowell  we  know  comparatively 
little,  but  of  the  great  original  ovariotomist  no 
one  at  all  concerned  in  the  progress  of  surgery 
can  be  ignorant.  As  a  Kentuckian  no  less 
than  as  a  surgeon  I  have  always  felt  the  deepest 
interest  in  his  history,  and  have  sought  in  his 
life  and  surroundings  to  penetrate  to  the  origin 
of  the  great  thought,  and  still  greater  courage, 
that  gave  expression  to  the  thought  which, 
without  the  sanction  of  precedent,  and  unaided 
by  the  advice  or  sympathy  of  others,  culminated 

35 


c45  MEMORIAL  SERVICES. 

in  the  institution  of  an  operation  by  which 
thousands  of  women  heretofore  doomed  to 
early  death  now  live  to  bless  his  name. 

But  who  can  discover  and  open  the  secret 
door  which  hides  from  profane  view  the  sacred 
laboratory  of  genius  ?  Or  who  can  trace  the 
footsteps  of  the  inspired  discoverer  as  he  works 
his  narrow  way  out  to  the  confines  of  human 
experience,  and  with  purged  eye  looks  into  the 
mysteries  which  lie  beyond  ?  All  that  we  can 
do  is  to  cheer  on  with  our  words  of  encourage- 
ment, and,  when  the  work  is  done,  with  willing 
hands  distribute  its  benefits  to  those  who  are  in 
need,  never  forgetting  to  pronounce  a  blessing 
upon  the  author.  In  this  spirit  of  humble 
reverence  I  bow  my  bared  head  before  him 
whom  you  this  day  exalt  in  the  sight  of  the 
whole  world  as  one  of  its  greatest  benefactors, 
and  proclaim  by  your  act  that  the  highest  and 
noblest  ambition  of  the  physician  should  be 
the  saving  of  human  life.  Who  is  there,  since 
the  days  of  Jenner,  who  can  in  this  respect 
compare  with  the  "  backwoods  surgeon  of  Ken- 
tucky? "  I  would  not  derogate  in  the  slightest 
degree  from  the  deserved  honor  which  belongs 
to  many  who  have  followed  their  profession 
with  equal  zeal  and  earnestness,  and  who  have 


CORRESPONDENCE.  547 

added  largely  to  the  resources  of  the  healing 
art,  but  in  the  inscrutable  wisdom  of  the  Creator 
of  all  things  it  has  not  been  given  to  any  other 
single  laborer  in  the  field  of  medicine  and  sur- 
gery upon  this  western  hemisphere  to  confer  so 
great  a  blessing  upon  the  human  race. 

All  honor  to  the  memory  of  Ephraim  Mc- 
Dowell, the  man  of  genius,  the  wise  and  heroic 
surgeon,  the  benefactor  of  his  kind.  When 
the  granite  shaft  which  you  have  erected  to 
signalize  what  he  was  and  what  he  did  shall 
have  fallen  into  decay,  his  name  will  still  be 
perpetuated  by  the  many  lives  saved  through 
his  instrumentality. 

I  am,  gentlemen,  with  great  esteem,  your 
obedient  servant, 

T.  G.  Richardson, 

New  Orleans,  May  9,  1879. 

L.  S.  McMurtry,  M.D., 

Chairman  McDowell  Monument  Committee. 

Dear  Sir  :  I  thank  you  very  much  for  your 
invitation  to  attend  the  meeting  connected  with 
the  McDowell  monument,  and  I  deeply  regret 
that  I  am  unable  to  leave  London  at  present. 

It  would  give  me  extreme  pleasure  to  be 
present  at  so  interesting  a  ceremony,  to  make 


548  MEMORIAL  SERVICES. 

the  acquaintance  of  so  many  of  my  American 
professional  brethren,  and  to  show  my  respect 
to  the  memory  of  "  the  Father  of  Ovariotomy." 
I  shall  hope  in  some  future  year  to  visit  your 
great  country  again,  and  to  see  the  monument 
you  have  raised  over  the  grave  of  McDowell. 
Very  sincerely, 

T.  Spencer  Wells. 

3  Upper  Grosvenor  Street,  London  W.,  April  24,  1879. 

L.  S.  McMurtry,  M.D., 

Chairman  McDowell  Monument  Committee. 

Dear  Sir:  I  regret  that  it  is  not  in  my  power 
to  renew  the  pleasure  of  a  former  visit  to  Ken- 
tucky and  take  part  in  the  exercises  at  the 
dedication  of  the  McDowell  monument,  at 
least  so  far  as  to  be  a  sympathetic  listener  to 
all  the  eloquence  which  the  occasion  will  call 
forth. 

.  I  feel  a  personal  interest  in  the  surgical  con- 
quest which  is  to  be  commemorated  in  addition 
to  that  which  all  the  world  recognizes.  Among 
the  births  of  the  century  this  is  a  twin  with  my- 
self. Dr.  McDowell's  first  operation  dates  from 
the  same  year  as  that  in  which  I  first  inhaled 
the  slow  poison  that  envelops  our  planet,  the 
effects   of  which  I  have  so  lone   survived.     I 


CORRESPONDENCE.  r4g 

thank  God  that  the  other  twin  will  long-  outlive 
me  and  my  memory,  carrying  the  light  of  life 
into  the  shadows  of  impending  doom,  the 
message  of  hope  into  the  dark  realm  of  de- 
spair ;  opening  the  prison  to  them  that  are 
bound  and  giving  them  beauty  for  ashes,  the 
beauty  of  a  new-born  existence  even,  it  may 
be,  as  I  have  but  recently  seen  it,  of  youthful 
and  happy  maternity  in  place  of  the  ashes  for 
which  the  inevitable  urn  seemed  already  wait- 
ing. 

I  am  glad  that  this  great  achievement  is  to 
be  thus  publicly  claimed  for  American  surgery. 
Our  trans-Atlantic  cousins  have  a  microphone 
which  enables  them  to  hear  the  lightest  foot- 
steps of  their  own  discoverers  and  inventors, 
but  they  need  a  telephone  with  an  ear-trumpet 
at  their  end  of  it  to  make  them  hear  anything 
of  that  sort  from  our  side  of  the  water.  There 
is  another  kind  of  trumpet  they  do  not  always 
find  themselves  unprovided  with,  as  those  who 
remember  Sir  James  Simpson's  astonishing 
article,  "Chloroform,"  in  the  eighth  edition  of 
the  Encyclop&dia  Britannica,  decently  omitted 
and  ignored  in  the  ninth  edition  of  the  same 
work,  do  not  need  tc  be  reminded. 

If  there  was  any  one  who  could  dispute  Dr. 


rr0  MEMORIAL  SERVICES. 

McDowell's  claim  to  be  called  "the  Father  of 
Ovariotomy"  it  would  have  been  our  own  Dr. 
Nathan  Smith — our  own  and  your  own  too,  for 
he  also  was  born  and  lived  and  died  on  the 
sunset  side  of  the  Atlantic,  and  within  the 
starry  circle  which  holds  us  all.  Dr.  Smith 
performed  the  operation  of  ovariotomy  with 
success  early  in  the  century,  but  unfortunately 
there  is  no  record,  so  far  as  I  know,  of  the 
exact  date.  I  allude  to  this  fact  not  to  invali- 
date Dr.  McDowell's  claim,  for  an  undated  case 
cannot  do  it,  but  to  couple  with  his  name  as  at 
least  next  in  priority  that  of  another  native 
American  practitioner  worthy  of  companionship 
with  the  greatest  and  the  best. 

A  single  thought  occurs  to  me  which  may 
help  to  give  this  occasion  something  more  than 
professional  significance.  Although  our  politi- 
cal independence  of  the  mother  country  has 
been  long  achieved,  our  scientific  and  literary 
independence  has  been  of  much  slower  growth. 

And  as  we  read  the  inscription  on  this  monu- 
ment, let  us  gratefully  remember  that  every 
bold,  forward  stride  like  this  grand  triumph  of 
American  science,  skill,  and  moral  courage, 
tends  to  bring  us  out  of  the  present  period  of 
tutelage  and  imitation   into   that   brotherhood 


CORRESPONDENCE.  5  5  l 

and  self-reliance  which  should  belong  to  a 
people  no  longer  a  colony  or  a  province,  but  a 
mighty  nation.  I  am,  dear  sir, 

Yours  very  truly, 
Oliver  Wendell  Holmes. 

Boston,  May  9,  1879. 

L.  S.  McMurtry,  M.D., 

Chairman  McDowell  Monument  Committee. 

My  dear  Sir  :  It  is  with  extreme  regret  that 
I  find  myself  prevented  from  accepting  your 
kind  invitation  to  take  part  in  the  dedication  of 
the  monument  to  the  "  Father  of  Ovariotomy." 
Although  absent  in  body  let  me  assure  you 
that  I  shall  be  present  in  spirit. 

Kentucky  cherishes  the  memory  of  many 
noble  sons,  but  nowhere  in  her  annals  can  she 
point  to  a  name  more  deserving  of  her  pride 
than  that  which  adorns  the  monument  erected 
to  commemorate  McDowell's  glory. 

Others  have  given  her  the  proud  records  of 
the  warrior,  the  statesman,  the  philosopher, 
and  the  philanthropist.  McDowell,  favored  by 
God  above  other  men,  has  already  bestowed 
upon  humanity  more  than  forty  thousand  years 
of  active  life,  and  insured  for  the  future  results 
which  will  surely  dwarf  those  of  the  past. 


$$2  MEMORIAL  SERVICES. 

The  noble  tribute  which  you  erect  in  his 
honor  will  last  long,  but  it  will  crumble  into 
dust  and  be  scattered  abroad  by  the  winds, 
while  his  memory  will  continue  to  live  green 
and  vigorous  in  the  hearts  of  a  grateful  pos- 
terity. 

With  sentiments  of  sincere  regard, 
I  am,  dear  sir, 

Very  truly  yours, 

T.  Gaillard  Thomas. 

294  Fifth  Avenue,  N.  Y.,  May  i,  1879. 


PRESENTATION    ADDRESS. 


Remarks  made  by  Prof.  Richard  O.  Cowling,  M.D., 
of  Louisville,  in  Presenting  the  Door-knocker 
of  Dr.  McDowell's  House  to  Dr.  Gross. 

Dr.  Gross,  the  Kentucky  State  Medical 
Society  thanks  you  for  the  beautiful  oration 
you  have  just  delivered  on  Ephraim  McDowell. 
Surely  hereafter,  when  history  shall  recall  his 
deeds  and  dwell  upon  his  memory,  it  will  relate 
how,  when  he  was  fifty  years  at  rest,  the  great- 
est of  living  surgeons  in  America  came  upon  a 
pilgrimage  of  a  thousand  miles  to  pronounce 
at  his  shrine  the  noble  words  you  have  spoken. 

The  Society  does  not  wish  that  you  should 
return  to  your  home  without  some  memento  of 
the  occasion  which  brought  you  here,  and  which 
shall  tell  you  also  of  the  admiration,  the  respect, 
and  the  affection  it  ever  bears  for  you. 

I  have  been  appointed  to  deliver  to  you  this 
simple  gift,  with  the  trust  and  the  belief  that  it 
will  always  pleasantly  recall  this  time  and  be  a 

(553) 


rrA  MEMORIAL  SERVICES. 

token  of  our  feelings  toward  you.  We  wished 
to  give  you  something  directly  connected  with 
McDowell,  and  it  occurred  to  us  that  this  me- 
mento of  the  dead  surgeon  would  be  most 
appropriate.  It  is  only  the  knocker  which  hung 
upon  his  door,  but  it  carries  much  meaning 
with  it. 

The  sweetest  memories  of  our  lives  are 
woven  about  our  domestic  emblems.  The 
hearthstone  around  which  we  have  gathered, 
the  chair  in  which  our  loved  ones  have  sat,  the 
cup  their  lips  have  kissed,  the  lute  their  hands 
have  swept— what  jewels  can  replace  their 
value?  Do  you  remember  the  enchantment 
that  Douglas  Jerrold  wove  about  a  hat-peg? 
How  at  the  christening  of  the  child  they  gave 
it  great  gifts  of  diamonds  and  pearls  and  laces  ; 
and  when  the  fairy  godmother  came,  and  they 
expected  that  she  would  eclipse  them  all  with 
the  magnificence  of  her  dowry,  how  she  gave  it 
simply  a  hat-peg  ?  They  wondered  what  good 
could  come  of  that.  The  boy  grew  to  be  a 
man.  In  wild  pursuits  his  riches  were  wasted, 
and  at  last  he  came  home  and  hung  his  hat 
upon  that  peg.  And  while  the  goodman's  hat 
was  hanging  there  peace  and  plenty  and  order 
and  affection  sprang  up  in  his  home,  and  the 
hat-peg  was  indeed  the  talisman  of  his  life. 


PRESENTA  T/OJV  ADDRESS.  555 

I  would  that  the  magician's  wand  were 
granted  me  a  while  to  weave  a  fitting  legend 
around  this  door-knocker,  which  comes  from 
McDowell  to  you,  Dr.  Gross.  There  is  much 
in  the  emblem.  No  one  knows  better  than 
you  how  good  and  how  great  was  the  man  of 
whom  it  speaks.  It  will  tell  of  many  a  summons 
upon  mercy's  mission  which  did  not  sound  in 
vain.  Ofttimes  has  it  roused  to  action  one 
whose  deeds  have  filled  the  world  with  fame. 
A  sentinel,  it  stood  at  the  doorway  of  a  happy 
and  an  honorable  home,  whose  master,  as  he  had 
bravely  answered  its  signals  to  duty  here  below, 
so  when  the  greater  summons  came,  as  trust- 
fully answered  that,  and  laid  down  a  stainless 
life. 

It  belongs  by  right  to  you,  Dr.  Gross.  This 
household  genius  passes  most  fittingly  from  the 
dearest  of  Kentucky's  dead  surgeons  to  the 
most  beloved  of  her  living  sons  in  medicine. 
She  will  ever  claim  you  as  her  son,  and  will 
look  with  jealous  eye  upon  those  who  would 
wean  you  from  her  dear  affection. 

And  as  this  emblem  which  now  is  given  to 
you  hangs  no  longer  in  a  Kentucky  doorway, 
by  this  token  you  shall  know  that  all  Kentucky 
doorways  are  open  at  your  approach.     By  the 


556  MEMORIAL  SERVICES. 

relief  your  skill  has  wrought ;  by  the  griefs 
your  great  heart  has  healed ;  by  the  sunshine 
you  have  thrown  across  her  threshold  ;  by  the 
honor  your  fame  has  brought  her ;  by  the 
fountains  of  your  wisdom  at  which  your  loving 
children  within  her  borders  have  drunk,  the 
people  of  Kentucky  shall  ever  open  to  you 
their  hearts  and  homes. 


DR.   GROSS'S    REPLY. 


I  am  much  overcome,  gentlemen  of  the  Ken- 
tucky State  Medical  Society,  by  this  mark  of 
your  approbation.  I  am  not  the  great  man 
your  speaker  has  declared  me  to  be,  but  I 
gratefully  appreciate  the  feelings  that  have 
prompted  his  words.  I  claim  to  be  but  an 
earnest  follower  of  Surgery,  who  during  a 
period  which  has  now  extended  beyond  half  a 
century,  has  striven  to  the  best  of  his  ability  to 
grasp  its  truths  and  to  extend  the  beneficence 
of  its  offices.  I  am  not  to  be  placed  by  the  side 
of  McDowell,  for  what  I  may  have  done  in  our 
art ;  but  if  this  reward  be  a  measure  of  the 
appreciation  I  hold  of  the  good-will  of  the 
people  in  this  Commonwealth,  I  may  claim  it 
for  that. 

The  years  of  my  life  which  I  passed  in  Ken- 
tucky represent  the  most  important  era  in  my 
career.  They  witnessed  many  of  its  struggles 
and  much  of  the  fruition  of  its  hopes.     To  the 

warm   hearts   of  the   many  friends   it  was  my 

(557) 


tjij8  MEMORIAL  SERVICES. 

good  fortune  to  secure  within  these  borders  do 
I  owe  it  that  those  struggles  were  cheered  and 
rewards  beyond  my  deserts  were  secured. 

I  take  this  emblem  now  offered  me  as  the 
most  valued  gift  of  my  life.  It  shall  be  received 
into  my  home  as  a  household  god,  environed  by 
all  the  memories  of  goodness  and  greatness  to 
which  your  speaker  has  referred,  and  above  all 
recalling  this  scene.  Dying  I  shall  bequeath 
it,  among  my  most  important  possessions,  to 
the  family  that  I  may  leave,  or  in  failure  of  that, 
to  be  preserved  in  the  archives  of  some  society. 

I  thank  you  again,  gentlemen,  and  I  wish  I 
were  able  to  tell  you  better  how  much  I  thank 
you. 


WoA 

COLUMBIA  UNIVERSITY  LIBRARIES 

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